Outcomes in patients with clinically suspected pedal osteomyelitis based on bone marrow signal pattern on MRI.

IF 1.8 Q3 INFECTIOUS DISEASES Journal of Bone and Joint Infection Pub Date : 2023-01-01 DOI:10.5194/jbji-8-99-2023
Christin A Tiegs-Heiden, Tanner C Anderson, Mark S Collins, Matthew P Johnson, Douglas R Osmon, Doris E Wenger
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Abstract

Objective: confluent T1 hypointense marrow signal is widely accepted to represent osteomyelitis on MRI. Some authors have suggested that non-confluent bone marrow signal abnormality should be considered early osteomyelitis. The purpose of this study was to address this issue by comparing the rate of osteomyelitis and amputation based on T1 marrow signal characteristics. Materials and methods: a total of 112 patients who underwent MRI of the foot for the evaluation of possible osteomyelitis were included. Patients were assigned to confluent T1 hypointense, reticulated T1 hypointense, and normal bone marrow signal groups. Results: patients with confluent T1 hypointense signal on MRI had significantly higher rates of osteomyelitis and amputation at 2 and 14 months post-MRI than the reticulated T1 hypointense group ( p < 0.001 ). Six patients had normal T1 signal, 16.7 % of whom had osteomyelitis and underwent amputation by 2 months post-MRI. Of 61 patients with reticulated T1 hypointense signal, 19.7 % had a diagnosis of osteomyelitis at 2 months post-MRI and 30.8 % had a diagnosis of osteomyelitis at 14 months post-MRI; moreover, 14.8 % and 31.5 % underwent amputation by 2 and 14 months post-MRI, respectively. Of 45 patients with confluent T1 hypointense signal, 73.3 % of patients had osteomyelitis at 2 months post-MRI and 82.5 % had osteomyelitis at 14 months post-MRI. In this group, 66.7 % underwent amputation by 2 months post-MRI and 77.8 % underwent amputation by 14 months post-MRI. Conclusions: over half of the patients with suspected pedal osteomyelitis who had reticulated or normal T1 bone marrow signal on MRI healed with conservative measures. Therefore, we recommend terminology such as "osteitis", "reactive osteitis", or "nonspecific reactive change" to describe bone marrow edema-like signal and reticulated hazy T1 hypointense signal without associated confluent T1 hypointensity. Moreover, we recommend that the MRI diagnosis of osteomyelitis is reserved for confluent T1 hypointense bone signal in the area of concern.

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基于MRI骨髓信号模式临床疑似足部骨髓炎患者的预后。
目的:骨髓融合T1低信号在MRI上被广泛接受为骨髓炎的表征。一些作者认为,早期骨髓炎应考虑骨髓信号不融合异常。本研究的目的是通过比较基于T1骨髓信号特征的骨髓炎和截肢率来解决这一问题。材料和方法:共纳入112例进行足部MRI检查以评估可能的骨髓炎的患者。将患者分为融合T1低信号组、网状T1低信号组和正常骨髓信号组。结果:MRI上合并T1低信号的患者在MRI后2个月和14个月的骨髓炎和截肢率明显高于网状T1低信号组(p < 0.001)。6例T1信号正常,16.7 %的患者在mri后2个月发生骨髓炎并截肢。61例网状T1低信号患者中,19.7 %在mri后2个月诊断为骨髓炎,30.8 %在mri后14个月诊断为骨髓炎;此外,14.8 %和31.5 %分别在mri后2个月和14个月截肢。在45例T1低信号融合患者中,73.3 %的患者mri后2个月出现骨髓炎,82.5 %的患者mri后14个月出现骨髓炎。在该组中,66.7 %的患者在mri后2个月截肢,77.8% %的患者在mri后14个月截肢。结论:MRI T1骨髓信号呈网状或正常的疑似足部骨髓炎患者,半数以上经保守治疗治愈。因此,我们建议使用“骨炎”、“反应性骨炎”或“非特异性反应性改变”等术语来描述骨髓水肿样信号和网状模糊T1低信号,但不伴有融合T1低信号。此外,我们建议MRI诊断骨髓炎应保留在相关区域的T1低信号骨信号。
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来源期刊
CiteScore
3.70
自引率
0.00%
发文量
29
审稿时长
12 weeks
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