MRI Diagnosis for Post-Traumatic Osteomyelitis of Extremities Using Conventional Metal-Artifact Reducing Protocols:
Bit Na Park1, Suk-Joo Hong1, Min A Yoon1
1Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul 08308, South Korea.
Rationale And Objectives:
To assess the diagnostic power of MR imaging features for post-traumatic osteomyelitis (PTOM) of the extremities with metal implants using a 3.0-T machine with conventional metal-artifact reducing (MAR) protocols.
Materials And Methods:
Between December 2012 and September 2016, 261 consecutive patients underwent MRI for clinical suspicion of PTOM in the appendicular skeleton at our hospital. A total of 72 enrolled patients with metal implants were divided into two groups, one with surgical, histologic, or microbiologic proven to be PTOM, and the other proven not to be PTOM. Their MR images were reviewed by two musculoskeletal radiologists who qualitatively analyzed various findings regarding PTOM, and concluded diagnosis of PTOM or without PTOM for each patient. All MR images were obtained using conventional MAR protocols.
Results:
The sensitivity, specificity, positive and negative predictive values, and accuracy of MR diagnosis by two observers were 55%/38%, 81%/93%, 67%/40%, 73%/78%, and 71%/71%, respectively. Among the findings, T1 low signal intensity, medullary location, confluent pattern, typical features (concurrence of T1 low signal intensity, medullary, and confluent patterns), heterogeneous or no enhancement, and cortical destruction were statistically significant by univariate analysis (p<0.05). Among these features, only medullary involvement was significant by multivariate analysis (p = 0.007). Medullary involvement and no enhancement pattern were significant by step-wise discrimination analysis. Interobserver correlation was moderate with a weighted kappa value of 0.512 (confidence interval: 0.3-0.723).
Conclusion:
The overall accuracy for diagnosis of PTOM of the extremities using 3.0-T MRI with conventional metal-artifact reduction parameters was 71%. The strongest diagnostic MR imaging feature was medullary involvement of T1 low signal intensity. PTOM of the extremities can be accurately diagnosed with a 3.0-T MR machine using conventional MAR protocols.
Insights
Diagnosing post-traumatic osteomyelitis (PTOM) in extremities with metal implants using 3.0-T MRI with metal-artifact reduction (MAR) protocols achieved 71% accuracy. Medullary involvement was the strongest indicator for PTOM.
Area of Science:
- Medical Imaging
- Orthopedic Surgery
- Infectious Diseases
Background:
- Post-traumatic osteomyelitis (PTOM) in the extremities presents diagnostic challenges, particularly with the presence of metal implants.
- Magnetic Resonance Imaging (MRI) is a key modality, but metal artifacts can impede accurate diagnosis.
Purpose of the Study:
- To evaluate the diagnostic performance of specific MRI features for PTOM in patients with extremity metal implants.
- To assess the utility of 3.0-T MRI with conventional metal-artifact reducing (MAR) protocols for PTOM diagnosis.
Main Methods:
- Retrospective review of 72 patients with suspected PTOM and metal implants who underwent 3.0-T MRI with MAR protocols.
- Two musculoskeletal radiologists qualitatively analyzed MRI findings and diagnosed PTOM or absence thereof.
- Statistical analysis, including univariate, multivariate, and stepwise discrimination, identified significant imaging features.
Main Results:
- Overall diagnostic accuracy for PTOM was 71%.
- Significant univariate findings included T1 low signal intensity, medullary location, confluent pattern, heterogeneous/no enhancement, and cortical destruction.
- Medullary involvement emerged as the strongest independent predictor in multivariate analysis.
Conclusions:
- 3.0-T MRI with conventional MAR protocols can accurately diagnose PTOM in extremities with metal implants.
- Medullary involvement, characterized by T1 low signal intensity, is the most significant MR imaging feature for diagnosing PTOM in this context.
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