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MRI edema patterns in acute neck infections: A multicenter and multidisciplinary interobserver study.

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Radiologists and surgeons accurately detect MRI edema patterns in neck infections, aiding clinical decisions. This study validates their use for risk stratification in emergency imaging.

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Area of Science:

  • Medical Imaging
  • Diagnostic Accuracy
  • Head and Neck Surgery

Background:

  • Prognostic MRI edema patterns, including retropharyngeal (RPE) and mediastinal (ME) edema, are crucial for assessing acute neck infection severity.
  • Reliable identification of these patterns across medical specialties is essential for clinical integration but has been under-evaluated.

Purpose of the Study:

  • To evaluate the diagnostic accuracy and interobserver agreement of radiologists and surgeons in identifying RPE and ME edema on MRI.
  • To support the integration of these prognostic MRI findings into emergency imaging workflows for acute neck infections.

Main Methods:

  • A multicenter observational study involved 28 readers (radiologists and surgeons) evaluating MRI from 60 patients with acute neck infections.
  • Readers assessed axial T2-weighted Dixon MRI for RPE and ME presence, blinded to clinical data.
  • Diagnostic performance metrics (sensitivity, specificity, accuracy) and interobserver agreement (Fleiss' kappa) were calculated against a neuroradiologist consensus.

Main Results:

  • High diagnostic accuracy was achieved for both RPE (0.87) and ME (0.85) edema patterns.
  • Substantial interobserver agreement was noted (κ=0.61 for RPE, 0.52 for ME).
  • Radiologists demonstrated superior performance over surgeons in detecting RPE and ME edema, with high intraobserver consistency (90%).

Conclusions:

  • Physicians demonstrate reliable detection of MRI edema patterns in acute neck infections, regardless of specialty.
  • These findings validate the use of MRI edema patterns for risk stratification.
  • Broader clinical adoption of these MRI assessments in emergency settings is supported.