Specific Magnetic Resonance Imaging Findings as Predictors of Osteomyelitis in Routine Clinical Practice

Veenu Gill

doi:10.31579/2690-1919/148

Abstract

Background: The gold standard for the diagnosis of osteomyelitis is histopathology combined with positive bone cultures. Magnetic Resonance Imaging (MRI) is often used to aide diagnosis and guide treatment decisions. The purpose of the study was to examine the association of MRI findings with, and their sensitivity and specificity in identifying osteomyelitis as proven by bone histopathology and bone culture in routine clinical practice. Materials and Methods: A retrospective analysis of patients with bone specimens obtained by biopsy or at resection for suspected osteomyelitis during 2010-2014 at an academic medical center in New York City. We used bivariate analysis to compare findings of patients who did or did not have osteomyelitis confirmed on histopathology (Analysis 1) and those who had either bone histopathology demonstrating osteomyelitis, positive bone cultures or both or who had neither (Analysis 2). Results: We identified 103 patients with an MRI in the week prior to bone biopsy or bone resection. In Analysis 1, 52 (50.5%) of 103 patients had osteomyelitis confirmed on histopathology. In Analysis 2, 72 (70%) patients had proven osteomyelitis. These groups with and without osteomyelitis did not differ significantly with respect to the frequency of marrow edema, cortical erosions, decreased T1 signal or increased T2 signal in either analysis and the sensitivity and specificity of MRI findings for detecting osteomyelitis was lower than reported in prior studies. Conclusions: Based on the above results, clinicians should be aware that the sensitivity and specificity of MRI findings for histologic and microbiologic osteomyelitis may be less in real world practice than is reported in formal studies.

Highlights

Osteomyelitis is a major public health issue
In routine clinical settings, it is not uncommon to encounter situations in which the sole Magnetic Resonance Imaging (MRI) finding e.g. bone marrow edema is sensitive but nonspecific and in which MRI findings may interpreted as ‘consistent with’ or ‘not able to exclude’ osteomyelitis; treatments decisions may be made based on these nondefinitive imaging findings and the clinical context [6,7,9]
This resulted in 103 patients who were included in the study and who had both MRI and pathology records available (Table 1)

Summary

Introduction

Osteomyelitis is a major public health issue. Osteomyelitis contributes to one in 675 United States (US) hospital admissions each year or about 50,000 cases annually [1]. The gold standard for the diagnosis of osteomyelitis is evidence of bone infection on pathologic specimens obtained through biopsy, debridement or resection) plus the presence of positive bone cultures [2, 3]. The purpose of the study was to examine the association of MRI findings with, and their sensitivity and specificity in identifying osteomyelitis as proven by bone histopathology and bone culture in routine clinical practice. In Analysis 2, 72 (70%) patients had proven osteomyelitis These groups with and without osteomyelitis did not differ significantly with respect to the frequency of marrow edema, cortical erosions, decreased T1 signal or increased T2 signal in either analysis and the sensitivity and specificity of MRI findings for detecting osteomyelitis was lower than reported in prior studies.

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Conclusion