He Angela, Guirguis Mina, Silva Flavio Duarte, Ashikyan Oganes, Pezeshk Parham, Rajamohan Naveen, Salhadar Karim, Xi Yin, Chhabra Avneesh
Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, United States.
Department of Orthopedic Surgery, UT Southwestern Medical Center, Dallas, Texas, United States.
Indian J Radiol Imaging. 2024 Aug 26;35(1):81-87. doi: 10.1055/s-0044-1789231. eCollection 2025 Jan.
The aim of this study was to determine the sensitivity and specificity and inter-reader reliability of previously known "ghost sign" and "penumbra sign" on T1-weighted (T1W) imaging and "ghost sign" on apparent diffusion coefficient (ADC) map in osteomyelitis (OM) of the extremities. In this cross-sectional retrospective study, two fellowship-trained musculoskeletal readers blinded to final diagnosis of OM versus no OM were asked to report the penumbra sign and ghost sign on T1W images and ghost sign on ADC map, as well as diagnosis of OM. Cohen's kappa was used. Diagnostic performance measures including sensitivity, specificity, and accuracy were calculated. A sample of 178 magnetic resonance imaging (MRI) scans of pathology-proven cases were included in this study, with 41 being positive for OM and 137 being negative for OM. There was a fair inter-reader agreement for imaging signs, and moderate agreement of 0.60 for OM. The sensitivities of the penumbra sign on T1W imaging, ghost sign on T1W imaging, and ghost sign on ADC map for OM are 3.7, 9.8, and 19.5%, respectively, while their respective specificities are 98.9, 97.8, and 94.5%, respectively. All three imaging signs showed a similar (good) accuracy of 76 to 78%. The ghost sign on ADC can be used as an additional marker for OM and is a similarly highly specific but a more sensitive sign for OM than the conventionally used penumbra sign and ghost sign on T1W imaging. The ghost sign on ADC can be used as a helpful indicator of osteomyelitis.Across two fellowship-trained musculoskeletal readers, there was a fair inter-reader agreement for imaging signs and moderate agreement for OM.The ghost sign on ADC is a similarly highly specific but a more sensitive sign for osteomyelitis than the conventionally used penumbra sign and ghost sign on T1W imaging. All three imaging signs showed a similar (good) accuracy of 76 to 78%.
本研究的目的是确定先前已知的“晕征”和“半暗带征”在T1加权（T1W）成像上以及“晕征”在肢体骨髓炎（OM）的表观扩散系数（ADC）图上的敏感性、特异性和阅片者间可靠性。
在这项横断面回顾性研究中，两名接受过专科培训的肌肉骨骼影像阅片者，在不知最终诊断为OM与否的情况下，被要求报告T1W图像上的半暗带征和晕征、ADC图上的晕征以及OM的诊断情况。采用Cohen's kappa系数进行分析。计算包括敏感性、特异性和准确性在内的诊断性能指标。
本研究纳入了178例经病理证实病例的磁共振成像（MRI）扫描，其中41例OM阳性，137例OM阴性。阅片者之间对影像征象的一致性尚可，对OM的一致性为中等程度，kappa值为0.60。T1W成像上半暗带征、T1W成像上晕征以及ADC图上晕征对OM的敏感性分别为3.7%、9.8%和19.5%，而它们各自的特异性分别为98.9%、97.8%和94.5%。所有三种影像征象的准确性相似（良好），为76%至78%。
ADC图上的晕征可作为OM的一个额外标志物，与传统使用的T1W成像上的半暗带征和晕征相比，它对OM具有相似的高特异性，但更为敏感。ADC图上的晕征可作为骨髓炎的一个有用指标。在两名接受过专科培训的肌肉骨骼影像阅片者之间，对影像征象的一致性尚可，对OM的一致性为中等程度。ADC图上的晕征与传统使用的T1W成像上的半暗带征和晕征相比，对骨髓炎具有相似的高特异性，但更为敏感。所有三种影像征象的准确性相似（良好），为76%至78%。
