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Quantitative Magnetic Resonance Imaging of Skeletal Muscle Disease
Published on: December 18, 2016
MSKI-RADS: An MRI-based Musculoskeletal Infection Reporting and Data System for the Diagnosis of Extremity Infections
Avneesh Chhabra1, Erin F Alaia1, Oganes Ashikyan1
1From the Departments of Radiology (A.C., O.A., A.E., A.K.T., P.P., U.T., F.D.S., N.R., M.G., A.H., K.S., Y.X.), Orthopaedic Surgery (A.C., K.R., D.K.W.), and Internal Medicine, Infectious Diseases (K.B.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9178; Department of Radiology, NYU Langone Medical Center, New York, NY (E.F.A.); Department of Diagnostic Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (P.K.W.); Department of Radiology, Hospital for Special Surgery, New York, NY (P.C.); Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, Ark (G.B., T.P.); Department of Radiology, Virginia Commonwealth University, Richmond, Va (J.A.V.); Department of Radiology, Cleveland Clinic, Cleveland, Ohio (C.S.); Department of Radiology, University of Miami Health System, Miami, Fla (F.N.C., T.S., F.F.d.S.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (A.K.); Department of Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University of Feinberg School of Medicine, Chicago, Ill (J.S.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (K.S.L.); Department of Radiology, University of Washington, Seattle, Wash (M.C.); and Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pa (W.B.M.).
Abstract:
Background Current terms used to describe the MRI findings for musculoskeletal infections are nonspecific and inconsistent. Purpose To develop and validate an MRI-based musculoskeletal infection classification and scoring system. Materials and Methods In this retrospective cross-sectional internal validation study, a Musculoskeletal Infection Reporting and Data System (MSKI-RADS) was designed. Adult patients with radiographs and MRI scans of suspected extremity infections with a known reference standard obtained between June 2015 and May 2019 were included. The scoring categories were as follows: 0, incomplete imaging; I, negative for infection; II, superficial soft-tissue infection; III, deeper soft-tissue infection; IV, possible osteomyelitis (OM); V, highly suggestive of OM and/or septic arthritis; VI, known OM; and NOS (not otherwise specified), nonspecific bone lesions. Interreader agreement for 20 radiologists from 13 institutions (intraclass correlation coefficient [ICC]) and true-positive rates of MSKI-RADS were calculated and the accuracy of final diagnoses rendered by the readers was compared using generalized estimating equations for clustered data. Results Among paired radiographs and MRI scans from 208 patients (133 male, 75 female; mean age, 55 years ± 13 [SD]), 20 were category I; 34, II; 35, III; 30, IV; 35, V; 18, VI; and 36, NOS. Moderate interreader agreement was observed among the 20 readers (ICC, 0.70; 95% CI: 0.66, 0.75). There was no evidence of correlation between reader experience and overall accuracy (P = .94). The highest true-positive rate was for MSKI-RADS I and NOS at 88.7% (95% CI: 84.6, 91.7). The true-positive rate was 73% (95% CI: 63, 80) for MSKI-RADS V. Overall reader accuracy using MSKI-RADS across all patients was 65% ± 5, higher than final reader diagnoses at 55% ± 7 (P < .001). Conclusion MSKI-RADS is a valid system for standardized terminology and recommended management of imaging findings of peripheral extremity infections across various musculoskeletal-fellowship-trained reader experience levels. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Schweitzer in this issue.
Insights
A new Musculoskeletal Infection Reporting and Data System (MSKI-RADS) offers standardized MRI terminology for musculoskeletal infections. This validated system improves diagnostic accuracy for extremity infections, aiding consistent patient management.
Area of Science:
- Radiology
- Musculoskeletal Imaging
- Infectious Disease Imaging
Background:
- Current MRI terminology for musculoskeletal infections lacks specificity and consistency.
- This ambiguity can lead to diagnostic challenges and varied management approaches.
Purpose of the Study:
- To develop and validate an MRI-based classification and scoring system for musculoskeletal infections.
- To establish standardized terminology for reporting MRI findings of extremity infections.
Main Methods:
- A retrospective cross-sectional study designed the Musculoskeletal Infection Reporting and Data System (MSKI-RADS).
- 208 adult patients with suspected extremity infections underwent radiography and MRI.
- Interreader agreement and true-positive rates were calculated for MSKI-RADS categories.
Main Results:
- Moderate interreader agreement (ICC, 0.70) was observed among 20 radiologists.
- MSKI-RADS demonstrated higher overall reader accuracy (65%) compared to final diagnoses (55%).
- True-positive rates varied by category, with MSKI-RADS I and NOS showing the highest at 88.7%.
Conclusions:
- MSKI-RADS is a valid system for standardizing MRI terminology in peripheral extremity infections.
- The system enhances diagnostic accuracy across varying levels of musculoskeletal fellowship training.
- Standardized reporting facilitates consistent management recommendations for musculoskeletal infections.
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