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MRI and Clinical Risk Indicators for Osteomyelitis
Dustin H Massel1,2,3, Nathaniel W Jenkins1,2,3, Augustus J Rush1,2,3
1Department of Orthopaedics, University of Miami, Miami, Florida (DHM, AJR, CJD, AA).
Abstract:
Introduction. The sensitivity and specificity for magnetic resonance imaging (MRI) diagnosis of osteomyelitis is 90% and 80%, respectively; findings include bone marrow edema, T2-weighted image hyperintensity (HI-T2WI), T1-weighted image confluent signal(CS-T1WI), and cortical erosion (CE). The goal is to determine which risk factors and MRI findings are most predictive of osteomyelitis. Materials and Methods. After institutional review board approval, records of patients who underwent bone biopsy of the foot/ankle between 2015 and 2017 were reviewed. Diagnosis was determined histologically. Blinded MRI review identified indicators of osteomyelitis: HI-T2WI, CS-T1WI, ulcer depth, and CE. Bivariate and multivariate regression determined an association between osteomyelitis and radiographic indicators. Results. Of 59 subjects, 41 (69.5%) and 18 (30.5%) had pathologic evidence of osteomyelitis or were indeterminate. The sensitivity and specificity by radiologist diagnosis was 51.4% and 91.7%, respectively. Diabetes (relative risk [RR]=2.9, 95% CI = 1.0.8-7.77, P = .034), CS-T1WI (RR = 1.6, 95% CI = 1.23-2.20, P < .001), and CE (RR = 1.8, 95% CI = 1.34-2.28, P < .001) were risk factors on bivariate analysis. Ulcer depth demonstrated a trend toward statistical significance. Diabetes (RR = 2.4, 95% CI = 1.00-5.69, P = .049) and CE (RR = 1.7, 95% CI = 1.27-2.37, P < .001) were independent risk factors on multivariate analysis. Discussion. Diabetes and CS-T1WI are independent risk factors for pedal osteomyelitis. Patients with diabetes, CS-T1WI, and CE should be evaluated for osteomyelitis with recommendation for bone biopsy in appropriate clinical settings.Levels of Evidence: Level III Retrospective Comparative Study.
Insights
Diabetes and specific MRI findings like confluent signal on T1-weighted images (CS-T1WI) and cortical erosion (CE) are key predictors of osteomyelitis in the foot and ankle. Early detection aids in timely bone biopsy and treatment.
Area of Science:
- Radiology
- Orthopedics
- Infectious Diseases
Background:
- Osteomyelitis diagnosis relies on imaging, with MRI showing 90% sensitivity and 80% specificity.
- Key MRI findings include bone marrow edema, hyperintensity on T2-weighted images (HI-T2WI), confluent signal on T1-weighted images (CS-T1WI), and cortical erosion (CE).
Purpose of the Study:
- To identify risk factors and MRI findings most predictive of osteomyelitis in foot and ankle biopsies.
- To evaluate the association between patient characteristics, MRI indicators, and histological diagnosis of osteomyelitis.
Main Methods:
- Retrospective review of 59 patients undergoing foot/ankle bone biopsy (2015-2017).
- Histological confirmation of osteomyelitis diagnosis.
- Blinded MRI review for indicators: HI-T2WI, CS-T1WI, ulcer depth, and CE.
- Bivariate and multivariate regression analysis to determine risk factors.
Main Results:
- Diabetes (RR=2.9), CS-T1WI (RR=1.6), and CE (RR=1.8) were significant risk factors on bivariate analysis.
- Diabetes (RR=2.4) and CE (RR=1.7) were independent risk factors on multivariate analysis.
- Radiologist diagnosis sensitivity was 51.4%, specificity 91.7%.
Conclusions:
- Diabetes and CS-T1WI are independent risk factors for pedal osteomyelitis.
- Patients with diabetes, CS-T1WI, and CE require careful evaluation for osteomyelitis.
- Bone biopsy is recommended for definitive diagnosis in appropriate clinical settings.
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