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Diffusion-Weighted Imaging Distinguishes Between Osteomyelitis, Bone Marrow Edema, and Healthy Bone on Forefoot Magnetic Resonance Imaging

Konrad Kruk, Tobias Dietrich, Simon Wildermuth, Sebastian Leschka, Andreas Toepfer, Stephan Wälti, Chan-Hi Olaf Kim, Sabine Guesewell & Tim Fischer

abstract

BACKGROUND
Diagnosis of osteomyelitis by imaging can be challenging. The feasibility of diffusion-weighted imaging (DWI) as ancillary sequence was evaluated in this study.

PURPOSE
To evaluate DWI for differentiation between osteomyelitis, bone marrow edema, and healthy bone on forefoot magnetic resonance imaging (MRI).

STUDY TYPE
Prospective.

SUBJECTS
A total of 60 consecutive patients undergoing forefoot MRI divided into three study groups (20 subjects each): osteomyelitis, bone marrow edema, and healthy bone.

FIELD STRENGTH/SEQUENCE
A 1.5T and 3T MRI scanners; readout-segmented multishot echo planar DWI.

ASSESSMENT
Two independent radiologists measured apparent diffusion coefficient (ADC) values within abnormal or healthy bone.

STATISTICAL TESTS
ADC values were compared between groups (pairwise t-test with Bonferroni-Holm correction for multiple testing). Intraclass correlation coefficient (ICC) was calculated to assess inter-reader agreement. Threshold ADC values were determined as the cutoffs that maximized the sum of sensitivity and specificity. Receiver operating characteristic (ROC) analysis was performed with statistical threshold of P < 0.05.

RESULTS
Inter-reader agreement was 0.92 in the healthy bone group and 0.78 in both the edema and osteomyelitis groups. Average ADC values were significantly different between groups: 1432 ± 222 × 10  mm /sec (osteomyelitis), 1071 ± 196 × 10  mm /sec (bone marrow edema), and 277 ± 89 × 10  mm /sec (healthy bone). A threshold ADC value of 534 × 10  mm /sec distinguishes between healthy and abnormal bone with specificity and sensitivity of 100% each. For distinction between osteomyelitis and bone marrow edema, two cutoff values were determined: a 95%-specificity cutoff indicating osteomyelitis (>1320 × 10  mm /sec) and a 95%-sensitivity cutoff indicating bone marrow edema (<1155 × 10  mm /sec). Diagnostic accuracy of 95% was achieved for 73% (29/40) of the subjects.

DATA CONCLUSION
DWI with ADC maps distinguishes between healthy and abnormal bone on forefoot MRI. Calculated cutoff values allow confirmation or exclusion of osteomyelitis in a high proportion of subjects.

EVIDENCE LEVEL
2 TECHNICAL EFFICACY: Stage 2.
   
citation Kruk K, Dietrich T, Wildermuth S, Leschka S, Toepfer A, Wälti S, Kim C H O, Guesewell S, Fischer T. Diffusion-Weighted Imaging Distinguishes Between Osteomyelitis, Bone Marrow Edema, and Healthy Bone on Forefoot Magnetic Resonance Imaging. J Magn Reson Imaging 2022;.
   
type journal paper/review (English)
date of publishing 01-02-2022
journal title J Magn Reson Imaging
ISSN electronic 1522-2586
PubMed 35106870
DOI 10.1002/jmri.28091