Gowda Prajwal, Ashikyan Oganes, Pezeshk Parham, Guirguis Mina, Archer Holden, Hoang Diana, Xi Yin, Chhabra Avneesh
Radiology Department, UT Southwestern, Dallas, TX, USA.
Radiology & Orthopedic Surgery Department, UT Southwestern, Dallas, TX, 75390-9178, USA.
Eur Radiol. 2023 Nov;33(11):8300-8309. doi: 10.1007/s00330-023-09734-6. Epub 2023 May 13.
To determine whether MRI provides improved diagnostic accuracy compared to radiography for the diagnosis of extremity osteomyelitis (OM) with multi-reader analysis.
In this cross-sectional study, three musculoskeletal fellowship-trained expert radiologists evaluated cases of suspected OM in two rounds-first using radiographs (XR), then with conventional MRI. Radiologic features consistent with OM were recorded. Each reader recorded individual findings on both modalities and rendered a binary diagnosis along with certainty of final diagnosis on a confidence scale of 1-5. This was compared with the pathology-proven diagnosis of OM to determine diagnostic performance. Intraclass correlation (ICC) and Conger's Kappa were used for statistics.
XR and MRIs of 213 pathology proven cases (51.5 years ± 14.0 years, mean ± St.Dev.) were included in this study, with 79 tested positive for OM and 98 were positive for a soft tissue abscess, with 78 patients being negative for both. In total, 139 were males and 74 females with bones of interest in the upper and lower extremities in 29 and 184 cases, respectively. MRI showed significantly higher sensitivity and negative predictive value than XR (p < 0.001 for both metrics). Conger's Kappa for OM diagnosis were 0.62 and 0.74 on XR and MRI, respectively. Reader confidence improved slightly from 4.54 to 4.57 when MRI was used.
MRI is a diagnostically more effective imaging modality than XR for finding extremity osteomyelitis with better inter-reader reliability.
This study validates the diagnosis of OM with MRI over XR but adds novelty because it is the largest study of its kind with a clear reference standard to guide clinician decision making.
• Radiography is the first-line imaging modality for musculoskeletal pathology but MRI can add value for infections. • MRI shows greater sensitivity for the diagnosis of osteomyelitis of the extremities than radiography. • This improved diagnostic accuracy makes MRI a better imaging modality for patients with suspected osteomyelitis.
通过多阅片者分析，确定与X线摄影相比，MRI在诊断肢体骨髓炎（OM）时是否能提高诊断准确性。
在这项横断面研究中，三位接受过肌肉骨骼影像学培训的专家放射科医生分两轮评估疑似OM的病例——首先使用X线片（XR），然后使用传统MRI。记录与OM一致的放射学特征。每位阅片者记录两种检查方式的个人发现，并做出二元诊断，同时以1-5的置信度给出最终诊断的确定性。将其与经病理证实的OM诊断进行比较，以确定诊断性能。组内相关系数（ICC）和康格kappa系数用于统计分析。
本研究纳入了213例经病理证实的病例的XR和MRI检查结果（平均年龄51.5岁±14.0岁，均值±标准差），其中79例OM检测呈阳性，98例软组织脓肿检测呈阳性，78例两者均为阴性。总共有139例男性和74例女性，上肢和下肢感兴趣骨骼的病例分别为29例和184例。MRI显示出比XR显著更高的敏感性和阴性预测值（两个指标的p值均<0.001）。XR和MRI诊断OM的康格kappa系数分别为0.62和0.74。使用MRI时，阅片者的信心从4.54略有提高到4.57。
对于发现肢体骨髓炎，MRI是一种比XR更有效的诊断成像方式，且阅片者间的可靠性更高。
本研究验证了MRI在诊断OM方面优于XR，但具有新颖性，因为这是同类研究中规模最大的，有明确的参考标准来指导临床医生决策。
•X线摄影是肌肉骨骼疾病的一线成像方式，但MRI对感染性疾病有附加价值。•MRI对肢体骨髓炎的诊断显示出比X线摄影更高的敏感性。•这种提高的诊断准确性使MRI成为疑似骨髓炎患者更好的成像方式。
