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Diagnostic performance comparison of conventional radiography to magnetic resonance imaging for suspected osteomyelitis of the extremities: a multi-reader study

  • Musculoskeletal
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objective

To determine whether MRI provides improved diagnostic accuracy compared to radiography for the diagnosis of extremity osteomyelitis (OM) with multi-reader analysis.

Methods

In this cross-sectional study, three musculoskeletal fellowship-trained expert radiologists evaluated cases of suspected OM in two rounds—first using radiographs (XR), then with conventional MRI. Radiologic features consistent with OM were recorded. Each reader recorded individual findings on both modalities and rendered a binary diagnosis along with certainty of final diagnosis on a confidence scale of 1–5. This was compared with the pathology-proven diagnosis of OM to determine diagnostic performance. Intraclass correlation (ICC) and Conger’s Kappa were used for statistics.

Results

XR and MRIs of 213 pathology proven cases (51.5 years ± 14.0 years, mean ± St.Dev.) were included in this study, with 79 tested positive for OM and 98 were positive for a soft tissue abscess, with 78 patients being negative for both. In total, 139 were males and 74 females with bones of interest in the upper and lower extremities in 29 and 184 cases, respectively. MRI showed significantly higher sensitivity and negative predictive value than XR (p < 0.001 for both metrics). Conger’s Kappa for OM diagnosis were 0.62 and 0.74 on XR and MRI, respectively. Reader confidence improved slightly from 4.54 to 4.57 when MRI was used.

Conclusions

MRI is a diagnostically more effective imaging modality than XR for finding extremity osteomyelitis with better inter-reader reliability.

Clinical relevance statement

This study validates the diagnosis of OM with MRI over XR but adds novelty because it is the largest study of its kind with a clear reference standard to guide clinician decision making.

Key Points

• Radiography is the first-line imaging modality for musculoskeletal pathology but MRI can add value for infections.

• MRI shows greater sensitivity for the diagnosis of osteomyelitis of the extremities than radiography.

• This improved diagnostic accuracy makes MRI a better imaging modality for patients with suspected osteomyelitis.

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Abbreviations

ACR:

American College of Radiology

CT:

Computed tomography

DFU:

Diabetic foot ulcer

DM:

Diabetes mellitus

DWI:

Diffusion-weighted imaging

GLM:

Generalized linear mixed model

ICC:

Interclass correlation

MR(I):

Magnetic resonance imaging

MRSA:

Methicillin-resistant Staphylococcus aureus

OM:

Osteomyelitis

PACS:

Picture Archival and Communications System

PPV/NPV:

Positive predictive value/negative predictive value

SD:

Standard deviation

T1W:

T-1 weighted

T2W:

T-2 weighted

XR:

Radiographs/X-ray

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Acknowledgements

We wish to acknowledge the efforts of expert bone pathologist Dr. Helena Hwang for providing images of the bone pathology.

Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

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

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

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

    Avneesh Chhabra

Authors
  1. Prajwal Gowda
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Corresponding author

Correspondence to Avneesh Chhabra.

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Guarantor

The scientific guarantor of this publication is Dr. Avneesh Chhabra, MD, MBA.

Conflict of interest

The authors of this manuscript declare relationships with the following companies:

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.

Deputy Editor of the European Radiology Editorial Board. He has not taken part in the review or selection process of this article.

PP, OA: Consultant: Image Biopsy Lab Inc.

The remaining authors declare no conflict of interest for this work.

Statistics and biometry

One of the authors, Dr. Yin Xi, PhD, has significant statistical expertise.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Some study subjects or cohorts have not been previously reported.

Methodology

• retrospective

• cross-sectional study

• performed at one institution

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Adjunct Faculty- Johns Hopkins University, University of Dallas and Walton Centre for Neuroscience, UK

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Gowda, P., Ashikyan, O., Pezeshk, P. et al. Diagnostic performance comparison of conventional radiography to magnetic resonance imaging for suspected osteomyelitis of the extremities: a multi-reader study. Eur Radiol 33, 8300–8309 (2023). https://doi.org/10.1007/s00330-023-09734-6

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  • DOI: https://doi.org/10.1007/s00330-023-09734-6

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