Adam D Singer1, Monica Umpierrez2, Aparna Kakarala2, Marcos C Schechter3, Michael Maceroli4, Gulshan B Sharma5, Ravi R Rajani6. 1. Department of Radiology and Imaging Sciences, Division of Musculoskeletal Imaging, Emory University Hospital, 59 Executive Park South, 4th Floor Suite 4009, Atlanta, GA, 30329, USA. Adamsinger82@gmail.com. 2. Department of Radiology and Imaging Sciences, Division of Musculoskeletal Imaging, Emory University Hospital, 59 Executive Park South, 4th Floor Suite 4009, Atlanta, GA, 30329, USA. 3. Department of Medicine, Division of Infectious Disease, Emory University Hospital, Atlanta, GA, USA. 4. Department of Orthopaedic Surgery, Emory University Hospital, Atlanta, GA, USA. 5. University of Calgary, Calgary, Alberta, T2N 1N4, Canada. 6. Department of Surgery, Division of Vascular Surgery, Emory University Hospital, Atlanta, GA, USA.
Abstract
OBJECTIVE: Compare a two sequence protocol to a standard protocol in the detection of pedal osteomyelitis (OM) and abscesses and to identify patients that benefit from a full protocol. MATERIALS AND METHODS: One hundred thirty-two foot MRIs ordered to assess for OM were enrolled, and the following items were extracted from the clinical reports: use of IV contrast, the presence of OM, reactive osteitis, and a soft tissue abscess. Using only one T1 nonfat-suppressed and one fluid sensitive fat-suppressed sequences, two experienced musculoskeletal radiologists reviewed each case for the presence of OM, reactive osteitis, or an abscess. A Kappa test was calculated to assess for interobserver agreement, and diagnostic performance was determined. The McNemar test was used to assess for the effect of contrast. RESULTS: Agreement between both observers and the clinical report on the presence of osteomyelitis was substantial ( k = 0.63 and 0.72, p < 0.001), while the agreement for abscess was fair (k = 0.29 and 0.38, p < 0.001). For osteomyelitis, both observers showed good accuracy (0.85 and 0.86). When screening bone for a normal versus abnormal case, this method was highly sensitive (0.97-0.98), but was less sensitive for abscess (0.63-0.75). Fifty-one percent of exams used contrast, and it did impact the diagnosis of abscess for one observer. CONCLUSION: This rapid protocol is accurate in making the diagnosis of OM, and its high sensitivity makes it useful to screen for patients that would benefit from a full protocol.
OBJECTIVE: Compare a two sequence protocol to a standard protocol in the detection of pedal osteomyelitis (OM) and abscesses and to identify patients that benefit from a full protocol. MATERIALS AND METHODS: One hundred thirty-two foot MRIs ordered to assess for OM were enrolled, and the following items were extracted from the clinical reports: use of IV contrast, the presence of OM, reactive osteitis, and a soft tissue abscess. Using only one T1 nonfat-suppressed and one fluid sensitive fat-suppressed sequences, two experienced musculoskeletal radiologists reviewed each case for the presence of OM, reactive osteitis, or an abscess. A Kappa test was calculated to assess for interobserver agreement, and diagnostic performance was determined. The McNemar test was used to assess for the effect of contrast. RESULTS: Agreement between both observers and the clinical report on the presence of osteomyelitis was substantial ( k = 0.63 and 0.72, p < 0.001), while the agreement for abscess was fair (k = 0.29 and 0.38, p < 0.001). For osteomyelitis, both observers showed good accuracy (0.85 and 0.86). When screening bone for a normal versus abnormal case, this method was highly sensitive (0.97-0.98), but was less sensitive for abscess (0.63-0.75). Fifty-one percent of exams used contrast, and it did impact the diagnosis of abscess for one observer. CONCLUSION: This rapid protocol is accurate in making the diagnosis of OM, and its high sensitivity makes it useful to screen for patients that would benefit from a full protocol.
Authors: Tammer Elmarsafi; Anagha Kumar; Paul S Cooper; John S Steinberg; Karen K Evans; Christopher E Attinger; Paul J Kim Journal: J Foot Ankle Surg Date: 2018-06-04 Impact factor: 1.286
Authors: Vivek Chadayammuri; Benoit Herbert; Jiandong Hao; Andreas Mavrogenis; Juan C Quispe; Ji Wan Kim; Heather Young; Mark Hake; Cyril Mauffrey Journal: Eur J Orthop Surg Traumatol Date: 2017-05-25