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Incremental value of diffusion weighted imaging over conventional MRI for the diagnosis of osteomyelitis of extremities

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Abstract

Objective

To determine the incremental value of diffusion weighted imaging (DWI) over conventional MR imaging in diagnosing extremity osteomyelitis (OM).

Materials and methods

In this cross-sectional study, three experienced musculoskeletal radiologists evaluated clinically suspected cases of extremity OM in two rounds—first on conventional MR imaging, and then conventional MR imaging combined with DWI 4–6 weeks later. The readers recorded a result of the presence or absence of OM and their diagnostic confidence on a 1–5 scale. Mean and minimum apparent diffusion coefficient (ADC) were measured. Pathology diagnosis served as the reference standard. Statistical analysis utilized intraclass correlation (ICC) and Conger’s kappa.

Results

A total of 213 scans of suspected OM were reviewed by three musculoskeletal radiologists with no significant changes in sensitivity (0.97, 0.97), specificity (0.97, 0.94), positive predictive value (0.91, 0.87), or negative predictive value (0.98, 0.98) between conventional MR imaging and MR imaging combined with DWI, respectively. Reader confidence did not significantly change with the addition of DWI (4.55 and 4.70, respectively). A high inter-reader agreement was observed for the diagnosis of OM, soft tissue abscess, and intraosseous abscess in both rounds. A higher mean (1.46+/−0.43 × 10−3 mm2/s > 0.64+/−0.47 × 10−3mm2/s) and minimum (1.18+/−0.45 × 10−3mm2/s > 0.37+/−0.44 × 10−3mm2/s) ADC value was associated with OM (p-value < 0.0001) with odds ratios of 1.34 and 1.31, respectively, for mean and minimum ADC of the involved bone.

Conclusion

DWI-derived ADC increase is associated with OM. The use of DWI slightly increases reader confidence in the diagnosis of OM; however, no significant incremental value over conventional MR imaging is seen for the final diagnosis of OM.

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Authors and Affiliations

  1. Radiology, UT Southwestern, Dallas, TX, USA

    Mina Guirguis, Parham Pezeshk, Oganes Ashikyan, Prajwal Gowda, Holden Archer, Diana Hoang, Yin Xi & Avneesh Chhabra

  2. Orthopedic Surgery, UT Southwestern, Dallas, TX, 75390-9178, USA

    Avneesh Chhabra

  3. Johns Hopkins University, Baltimore, MD, USA

    Avneesh Chhabra

  4. University of Dallas, Richardson, TX, USA

    Avneesh Chhabra

  5. Walton Centre for Neuroscience, Liverpool, UK

    Avneesh Chhabra

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  1. Mina Guirguis
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Correspondence to Avneesh Chhabra.

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Conflict of interest

AC: Consultant—ICON Medical and TREACE Medical Concepts Inc.; Book Royalties—Jaypee, Wolters; Speaker—Siemens; Medical advisor—Image Biopsy Lab Inc.; Research grant—Image Biopsy Lab Inc.

PP, OA: Consultant—Image Biopsy Lab Inc.

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Supplementary information

ESM 1:

Supplementary Table 1: Diagnostic accuracy measures for each reader and pooled assessment for cMRI vs. MR + DWI for cases with diabetes. Supplementary Table 2: Diagnostic accuracy measures for each reader and pooled assessment for cMRI vs. MR + DWI for cases without diabetes. Supplementary Table 3: Diagnostic accuracy measures for each reader and pooled assessment for cMRI vs. MR + DWI for cases with contrast available. Supplementary Table 4: Diagnostic accuracy measures for each reader and pooled assessment for cMRI vs. MR + DWI for cases without contrast available.

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Guirguis, M., Pezeshk, P., Ashikyan, O. et al. Incremental value of diffusion weighted imaging over conventional MRI for the diagnosis of osteomyelitis of extremities. Skeletal Radiol 52, 1669–1682 (2023). https://doi.org/10.1007/s00256-023-04331-6

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  • DOI: https://doi.org/10.1007/s00256-023-04331-6

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