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Comparison between ZOOMit DWI and conventional DWI in the assessment of foot and ankle infection: a prospective study
Shuda Xia1, Prajwal Gowda1, Flavio Duarte Silva1
1UT Southwestern, Dallas, TX, USA.
Objective:
The study aimed to compare ZOOMit diffusion-weighted imaging (DWI) MRI with conventional DWI MRI for visualizing small bones in the foot, soft tissue abscesses, and osteomyelitis.
Materials And Methods:
The cohort consisted of a consecutive series of patients with potential foot and ankle infections referred for MR imaging. Patients were imaged using both conventional and ZOOMit DWI in the same setting. Blinded reads were then conducted in separate settings and independent of known clinical diagnosis by two expert radiologists. The results from the reads were compared statistically using paired t-tests and with biopsy specimen analysis, both anatomopathological and microbiological.
Results:
There was improvement in fat suppression using ZOOMit sequence compared to conventional DWI (p = .001) with no significant difference in motion artifacts (p = .278). ZOOMit had a higher rate of concordance with pathology findings for osteomyelitis (72%, 31/43 cases) compared with conventional DWI (60%, 26/43 cases). ZOOMit also identified 46 additional small bones of the foot and ankle (405/596, 68.0%) than conventional DWI (359/596, 60.2%). Conventional DWI however exhibited a more negative contrast-to-noise ratio (CNR) than ZOOMit (p = 0.001).
Conclusion:
ZOOMit DWI improves distal extremity proton diffusion assessment and helps visualize more bones in the foot, with less image distortion and improved fat saturation at the expense of reduced CNR. This makes it a viable option for assessing lower extremity infections.
Clinical Relevance Statement:
This study highlights the novel utilization of ZOOMit diffusion-weighted imaging (DWI) for the assessment of lower extremity lesions compared to conventional DWI.
Key Points:
• Distal extremity diffusion-weighted imaging (DWI) is often limited. • ZOOMit DWI displayed improved fat suppression with less motion artifacts and better visualization of the lower extremity bones than conventional DWI. • ZOOMit shows decreased contrast-to-noise ratio than conventional DWI.
Insights
ZOOMit diffusion-weighted imaging (DWI) MRI offers improved visualization of foot bones and soft tissues for lower extremity infections compared to conventional DWI. While it has a reduced contrast-to-noise ratio, ZOOMit enhances fat suppression and bone detail.
Area of Science:
- Radiology
- Medical Imaging
- Orthopedics
Background:
- Conventional diffusion-weighted imaging (DWI) MRI can be limited in visualizing small bones and soft tissues in the distal extremities.
- Assessing lower extremity infections like osteomyelitis requires high-resolution imaging for accurate diagnosis.
Purpose of the Study:
- To compare the efficacy of ZOOMit DWI MRI against conventional DWI MRI for visualizing small bones, soft tissue abscesses, and osteomyelitis in the foot and ankle.
- To evaluate image quality parameters including fat suppression and motion artifacts.
Main Methods:
- A cohort of patients with suspected foot and ankle infections underwent MR imaging using both conventional and ZOOMit DWI sequences.
- Two expert radiologists performed blinded reads, comparing image quality and diagnostic findings.
- Statistical analysis included paired t-tests and comparison with pathological and microbiological biopsy results.
Main Results:
- ZOOMit DWI demonstrated significantly improved fat suppression (p = .001) compared to conventional DWI, with no significant difference in motion artifacts (p = .278).
- ZOOMit showed higher concordance with pathology for osteomyelitis (72% vs. 60%) and identified more small bones (68.0% vs. 60.2%).
- Conventional DWI had a more negative contrast-to-noise ratio (CNR) than ZOOMit (p = 0.001).
Conclusions:
- ZOOMit DWI enhances the assessment of distal extremity proton diffusion, improving visualization of bones and soft tissues with reduced image distortion and better fat saturation.
- Despite a decreased CNR, ZOOMit DWI is a viable option for evaluating lower extremity infections.
- This novel application of ZOOMit DWI offers advantages over conventional DWI for lower extremity lesion assessment.
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