Reevaluating Magnetic Resonance Imaging in Radiographically Suspected Osteomyelitis of the Toe

Area of Science:

• Orthopedics
• Radiology
• Infectious Diseases

Background:

• Osteomyelitis diagnosis and surgical planning often rely on Magnetic Resonance Imaging (MRI).
• Plain radiographs can sometimes reveal the extent of osseous infection, potentially limiting MRI's added value.
• Assessing the accuracy of radiographs versus MRIs in detecting osteomyelitis spread is crucial for effective treatment.

Purpose of the Study:

• To evaluate the diagnostic accuracy of plain radiographs compared to MRI.
• To determine if radiographs can reliably assess the spread of osteomyelitis between phalanges and to the metatarsal bone.
• To ascertain if radiographic findings alone are sufficient for preoperative planning in cases of phalangeal osteomyelitis.

Main Methods:

• Retrospective review of 14 patients with 16 affected toes diagnosed with osteomyelitis.
• Radiographic and clinical presentations were used to assess the extent of osseous involvement by an MRI-blinded investigator.
• Accuracy of radiographic assessment was compared against MRI findings.

Main Results:

• Radiographs accurately determined osteomyelitis spread in 14 out of 16 toes (87.5%).
• One case showed inadequate depiction of adjacent infected bone on radiographs.
• One case incorrectly suggested osteomyelitis in uninfected bone based on radiographs.

Conclusions:

• Plain radiographs are highly accurate in assessing the spread of osteomyelitis in the phalanges and to the metatarsal.
• Radiographic findings are often sufficient for preoperative planning, potentially reducing reliance on MRI.
• This suggests radiographs are a valuable tool in managing phalangeal osteomyelitis.