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Quantitative Magnetic Resonance Imaging of Skeletal Muscle Disease

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Ghost Sign on Diffusion-Weighted Imaging Generated Apparent Diffusion Coefficient Map: Additional MRI Diagnostic

Angela He¹, Mina Guirguis¹, Flavio Duarte Silva¹

¹Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, United States.

The Indian Journal of Radiology & Imaging

|December 19, 2024

Summary

The ghost sign on apparent diffusion coefficient (ADC) maps is a more sensitive indicator for osteomyelitis (OM) than T1-weighted imaging signs. This highly specific sign aids in diagnosing OM, showing good accuracy similar to other methods.

Keywords:

DWI MRI ghost sign osteomyelitis penumbra sign

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Area of Science:

Radiology
Medical Imaging
Orthopedics

Background:

Osteomyelitis (OM) diagnosis relies on imaging.
T1-weighted (T1W) imaging signs like the "ghost sign" and "penumbra sign" are used.
The diagnostic performance of these signs, especially on ADC maps, requires further evaluation.

Purpose of the Study:

To assess the sensitivity, specificity, and inter-reader reliability of "ghost sign" and "penumbra sign" on T1W imaging.
To evaluate the "ghost sign" on apparent diffusion coefficient (ADC) maps for diagnosing extremity OM.
To compare the diagnostic accuracy of these imaging signs.

Main Methods:

Retrospective cross-sectional study of 178 MRI scans (41 OM, 137 non-OM).
Two musculoskeletal radiologists independently assessed T1W and ADC map signs, blinded to diagnosis.
Diagnostic performance metrics (sensitivity, specificity, accuracy) and Cohen's kappa for inter-reader agreement were calculated.

Main Results:

Inter-reader agreement was fair for imaging signs and moderate (0.60) for OM diagnosis.
Sensitivities for OM were low: penumbra sign (T1W) 3.7%, ghost sign (T1W) 9.8%, ghost sign (ADC) 19.5%.
Specificities were high: penumbra sign (T1W) 98.9%, ghost sign (T1W) 97.8%, ghost sign (ADC) 94.5%. All signs showed good accuracy (76-78%).

Conclusions:

The ghost sign on ADC maps is a highly specific and more sensitive marker for OM than T1W signs.
While all evaluated signs have good accuracy, the ghost sign on ADC offers improved sensitivity.
The ghost sign on ADC can serve as a valuable additional tool for osteomyelitis detection.