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Comparison between ZOOMit DWI and conventional DWI in the assessment of foot and ankle infection: a prospective study

  • Musculoskeletal
  • Published:
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Abstract

Objective

The study aimed to compare ZOOMit diffusion-weighted imaging (DWI) MRI with conventional DWI MRI for visualizing small bones in the foot, soft tissue abscesses, and osteomyelitis.

Materials and methods

The cohort consisted of a consecutive series of patients with potential foot and ankle infections referred for MR imaging. Patients were imaged using both conventional and ZOOMit DWI in the same setting. Blinded reads were then conducted in separate settings and independent of known clinical diagnosis by two expert radiologists. The results from the reads were compared statistically using paired t-tests and with biopsy specimen analysis, both anatomopathological and microbiological.

Results

There was improvement in fat suppression using ZOOMit sequence compared to conventional DWI (p = .001) with no significant difference in motion artifacts (p = .278). ZOOMit had a higher rate of concordance with pathology findings for osteomyelitis (72%, 31/43 cases) compared with conventional DWI (60%, 26/43 cases). ZOOMit also identified 46 additional small bones of the foot and ankle (405/596, 68.0%) than conventional DWI (359/596, 60.2%). Conventional DWI however exhibited a more negative contrast-to-noise ratio (CNR) than ZOOMit (p = 0.001).

Conclusion

ZOOMit DWI improves distal extremity proton diffusion assessment and helps visualize more bones in the foot, with less image distortion and improved fat saturation at the expense of reduced CNR. This makes it a viable option for assessing lower extremity infections.

Clinical relevance statement

This study highlights the novel utilization of ZOOMit diffusion-weighted imaging (DWI) for the assessment of lower extremity lesions compared to conventional DWI.

Key Points

• Distal extremity diffusion-weighted imaging (DWI) is often limited.

• ZOOMit DWI displayed improved fat suppression with less motion artifacts and better visualization of the lower extremity bones than conventional DWI.

• ZOOMit shows decreased contrast-to-noise ratio than conventional DWI.

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Abbreviations

ACR:

American College of Radiology

ADC:

Apparent diffusion coefficient

CNR:

Contrast-to-noise ratio

DFO:

Diabetic foot osteomyelitis

DWI:

Diffusion-weighted imaging

ICC:

Intraclass observer correlation

MoCI:

Motion correct imaging

MSK:

Musculoskeletal

MT:

Metatarsal

OM:

Osteomyelitis

RESOLVE:

Readout segmentation of long variable echo-trains

SD:

Standard deviation

SNR:

Signal-to-noise ratio

SPAIR:

Spectral adiabatic inversion recovery fat saturation

T1W:

T-1 weighted

T2W:

T-2 weighted

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Funding

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

Author information

Authors and Affiliations

  1. UT Southwestern, Dallas, TX, USA

    Shuda Xia, Prajwal Gowda, Flavio Duarte Silva, Mina Guirguis, Varun Ravi, Yin Xi & Avneesh Chhabra

  2. Radiology & 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

Authors
  1. Shuda Xia
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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, FACR.

Conflict of interest

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

Avneesh Chhabra: 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.

Avneesh Chhabra is a Deputy Editor in European Radiology. He has not taken part in the review or selection process of this article.

The other 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 obtained from all participants.

Ethical approval

Institutional Review Board approval of UT Southwestern was obtained.

Study subjects or cohorts overlap

None.

Methodology

• prospective

• observational

• performed at one institution

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Xia, S., Gowda, P., Silva, F.D. et al. Comparison between ZOOMit DWI and conventional DWI in the assessment of foot and ankle infection: a prospective study. Eur Radiol 34, 3483–3492 (2024). https://doi.org/10.1007/s00330-023-10315-w

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  • DOI: https://doi.org/10.1007/s00330-023-10315-w

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