From the Departments of Radiology (A.C., O.A., A.E., A.K.T., P.P., U.T., F.D.S., N.R., M.G., A.H., K.S., Y.X.), Orthopaedic Surgery (A.C., K.R., D.K.W.), and Internal Medicine, Infectious Diseases (K.B.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9178; Department of Radiology, NYU Langone Medical Center, New York, NY (E.F.A.); Department of Diagnostic Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (P.K.W.); Department of Radiology, Hospital for Special Surgery, New York, NY (P.C.); Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, Ark (G.B., T.P.); Department of Radiology, Virginia Commonwealth University, Richmond, Va (J.A.V.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (C.S.); Department of Radiology, University of Miami Health System, Miami, Fla (F.N.C., T.S., F.F.d.S.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (A.K.); Department of Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University of Feinberg School of Medicine, Chicago, Ill (J.S.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (K.S.L.); Department of Radiology, University of Washington, Seattle, Wash (M.C.); and Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pa (W.B.M.).
Radiology. 2024 Aug;312(2):e232914. doi: 10.1148/radiol.232914.
Background Current terms used to describe the MRI findings for musculoskeletal infections are nonspecific and inconsistent. Purpose To develop and validate an MRI-based musculoskeletal infection classification and scoring system. Materials and Methods In this retrospective cross-sectional internal validation study, a Musculoskeletal Infection Reporting and Data System (MSKI-RADS) was designed. Adult patients with radiographs and MRI scans of suspected extremity infections with a known reference standard obtained between June 2015 and May 2019 were included. The scoring categories were as follows: 0, incomplete imaging; I, negative for infection; II, superficial soft-tissue infection; III, deeper soft-tissue infection; IV, possible osteomyelitis (OM); V, highly suggestive of OM and/or septic arthritis; VI, known OM; and NOS (not otherwise specified), nonspecific bone lesions. Interreader agreement for 20 radiologists from 13 institutions (intraclass correlation coefficient [ICC]) and true-positive rates of MSKI-RADS were calculated and the accuracy of final diagnoses rendered by the readers was compared using generalized estimating equations for clustered data. Results Among paired radiographs and MRI scans from 208 patients (133 male, 75 female; mean age, 55 years ± 13 [SD]), 20 were category I; 34, II; 35, III; 30, IV; 35, V; 18, VI; and 36, NOS. Moderate interreader agreement was observed among the 20 readers (ICC, 0.70; 95% CI: 0.66, 0.75). There was no evidence of correlation between reader experience and overall accuracy ( = .94). The highest true-positive rate was for MSKI-RADS I and NOS at 88.7% (95% CI: 84.6, 91.7). The true-positive rate was 73% (95% CI: 63, 80) for MSKI-RADS V. Overall reader accuracy using MSKI-RADS across all patients was 65% ± 5, higher than final reader diagnoses at 55% ± 7 ( < .001). Conclusion MSKI-RADS is a valid system for standardized terminology and recommended management of imaging findings of peripheral extremity infections across various musculoskeletal-fellowship-trained reader experience levels. © RSNA, 2024 See also the editorial by Schweitzer in this issue.
背景 当前用于描述肌肉骨骼感染的 MRI 发现的术语不明确且不一致。
目的 制定并验证一种基于 MRI 的肌肉骨骼感染分类和评分系统。
材料与方法 在这项回顾性横断面内部验证研究中，设计了一种肌肉骨骼感染报告和数据系统（MSKI-RADS）。纳入了 2015 年 6 月至 2019 年 5 月期间接受疑似四肢感染放射和 MRI 扫描且有已知参考标准的成年患者。评分类别如下：0 项，不完全成像；1 项，无感染；2 项，浅表软组织感染；3 项，深部软组织感染；4 项，可能骨髓炎（OM）；5 项，高度提示 OM 和/或化脓性关节炎；6 项，已知 OM；NOS（未特指），非特异性骨病变。对来自 13 家机构的 20 名放射科医生（组内相关系数 [ICC]）的 20 次读片进行了读者间一致性评估，并使用广义估计方程比较了读者最终诊断的准确性。
结果 在 208 例患者（133 例男性，75 例女性；平均年龄，55 岁±13[标准差]）的配对放射和 MRI 扫描中，20 例为 1 类；34 例为 2 类；35 例为 3 类；30 例为 4 类；35 例为 5 类；18 例为 6 类；36 例为 NOS。20 名读者的读者间一致性为中度（ICC，0.70；95%CI：0.66，0.75）。未发现读者经验与总体准确性之间存在相关性（ =.94）。MSKI-RADS I 和 NOS 的阳性预测值最高，为 88.7%（95%CI：84.6，91.7）。MSKI-RADS V 的阳性预测值为 73%（95%CI：63，80）。使用 MSKI-RADS 对所有患者进行的总体读者准确率为 65%±5，高于最终读者诊断的 55%±7（<.001）。
结论 MASKI-RADS 是一种用于标准化术语的有效系统，建议在各种肌肉骨骼专科培训读者经验水平下对四肢外周感染的影像学表现进行推荐管理。
© 2024 RSNA，见本期社论。
