Ana I Garcia Diez1, David Fuster2, Laura Morata3, Ferran Torres4, Ruben Garcia5, Daniel Poggio6, Santiago Sotes7, Montserrat Del Amo8, Jaime Isern-Kebschull9, Jaume Pomes10, Alex Soriano11, Laura Brugnara12, Xavier Tomas13. 1. Department of Radiology; August Pi i Sunyer Biomedical Research Institute (IDIBAPS). Electronic address: aigarcia@clinic.cat. 2. Department of Nuclear Medicine. Electronic address: dfuster@clinic.cat. 3. August Pi i Sunyer Biomedical Research Institute (IDIBAPS); Service of Infectious Diseases. Electronic address: lmorata@clinic.cat. 4. Biostatistics Unit. Electronic address: Ferran.Torres@uab.cat. 5. Department of Orthopedic Surgery. Electronic address: rgarciae@clinic.cat. 6. Department of Orthopedic Surgery. Electronic address: dpoggio@clinic.cat. 7. Department of Radiology. Electronic address: ssotes@clinic.cat. 8. Department of Radiology. Electronic address: mdelamo@clinic.cat. 9. Department of Radiology. Electronic address: isern@clinic.cat. 10. Department of Radiology. Electronic address: jpomes@clinic.cat. 11. August Pi i Sunyer Biomedical Research Institute (IDIBAPS); Service of Infectious Diseases. Electronic address: asoriano@clinic.cat. 12. August Pi i Sunyer Biomedical Research Institute (IDIBAPS); Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM). Electronic address: lbrugnara@ciberdem.org. 13. Department of Radiology. Electronic address: xtomas@clinic.cat.
Abstract
PURPOSE: To compare the diagnostic accuracy of diffusion-weighted imaging (DWI) and dynamic contrast-enhanced-magnetic resonance imaging (DCE-MRI) involving two region of interest (ROI) sizes with 18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) to differentiate diabetic foot osteomyelitis (DFO) from Charcot neuro-osteoarthropathy (CN). METHOD: Thirty-one diabetic patients were included in this prospective study. Two readers independently evaluated DWI (apparent diffusion coefficient [ADC] and high-b-value signal pathological-to-normal bone ratio [DWIr]) and DCE-MRI parameters (Ktrans, Kep, Ve, internal area under the gadolinium curve at 60 s [iAUC60] and time intensity curve [TIC]) using two different ROI sizes, and 18F-FDG PET/CT parameters (visual assessment, SUVmax, delayed SUVmax, and percentage changes between SUVmax and delayed SUVmax). Techniques were compared by univariate analysis using the area under the receiver operating characteristic curve [AUC]. Reliability was analyzed with Kappa and Intraclass correlation [ICC]. RESULTS: DWIr, Ktrans and iAUC60 showed better diagnostic accuracy (AUC = 0.814-0.830) and reliability (ICC > 0.9) for large than for small ROIs (AUC = 0.736-0.750; ICC = 0.6 in Ktrans, 0.8 in DWIr and iAUC60). TIC showed moderate diagnostic performance (AUC = 0.739-0.761) and reliability (κ 0.7). Visual assessment of 18F-FDG PET/CT demonstrated a significantly higher accuracy (AUC = 0.924) than MRI parameters. Semi-quantitative 18F-FDG PET/CT parameters did not provide significant improvement over visual analysis (AUC = 0.848-0.903). CONCLUSION: DWIr, Ktrans and iAUC60 allowed reliable differentiation of DFO and CN, particularly for large ROIs. Visual assessment of 18F-FDG PET/CT was the most accurate technique for differentiation.
PURPOSE: To compare the diagnostic accuracy of diffusion-weighted imaging (DWI) and dynamic contrast-enhanced-magnetic resonance imaging (DCE-MRI) involving two region of interest (ROI) sizes with 18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) to differentiate diabetic foot osteomyelitis (DFO) from Charcot neuro-osteoarthropathy (CN). METHOD: Thirty-one diabeticpatients were included in this prospective study. Two readers independently evaluated DWI (apparent diffusion coefficient [ADC] and high-b-value signal pathological-to-normal bone ratio [DWIr]) and DCE-MRI parameters (Ktrans, Kep, Ve, internal area under the gadolinium curve at 60 s [iAUC60] and time intensity curve [TIC]) using two different ROI sizes, and 18F-FDG PET/CT parameters (visual assessment, SUVmax, delayed SUVmax, and percentage changes between SUVmax and delayed SUVmax). Techniques were compared by univariate analysis using the area under the receiver operating characteristic curve [AUC]. Reliability was analyzed with Kappa and Intraclass correlation [ICC]. RESULTS: DWIr, Ktrans and iAUC60 showed better diagnostic accuracy (AUC = 0.814-0.830) and reliability (ICC > 0.9) for large than for small ROIs (AUC = 0.736-0.750; ICC = 0.6 in Ktrans, 0.8 in DWIr and iAUC60). TIC showed moderate diagnostic performance (AUC = 0.739-0.761) and reliability (κ 0.7). Visual assessment of 18F-FDG PET/CT demonstrated a significantly higher accuracy (AUC = 0.924) than MRI parameters. Semi-quantitative 18F-FDG PET/CT parameters did not provide significant improvement over visual analysis (AUC = 0.848-0.903). CONCLUSION: DWIr, Ktrans and iAUC60 allowed reliable differentiation of DFO and CN, particularly for large ROIs. Visual assessment of 18F-FDG PET/CT was the most accurate technique for differentiation.
Authors: Katie Rubitschung; Amber Sherwood; Andrew P Crisologo; Kavita Bhavan; Robert W Haley; Dane K Wukich; Laila Castellino; Helena Hwang; Javier La Fontaine; Avneesh Chhabra; Lawrence Lavery; Orhan K Öz Journal: Int J Mol Sci Date: 2021-10-26 Impact factor: 5.923
Authors: Jennifer S Weaver; Imran M Omar; Winnie A Mar; Andrea S Klauser; Blair A Winegar; Gary W Mlady; Wendy E McCurdy; Mihra S Taljanovic Journal: Pol J Radiol Date: 2022-03-05