Search

Objective  The aim of this study was to determine the sensitivity and specificity and inter-reader reliability of previously known "ghost sign" and "penumbra sign" on T1-weighted (T1W) imaging and "ghost sign" on apparent diffusion coefficient (ADC) map in osteomyelitis (OM) of the extremities. Materials and Methods  In this cross-sectional retrospective study, two fellowship-trained musculoskeletal readers blinded to final diagnosis of OM versus no OM were asked to report the penumbra sign and ghost sign on T1W images and ghost sign on ADC map, as well as diagnosis of OM. Cohen's kappa was used. Diagnostic performance measures including sensitivity, specificity, and accuracy were calculated. Results  A sample of 178 magnetic resonance imaging (MRI) scans of pathology-proven cases were included in this study, with 41 being positive for OM and 137 being negative for OM. There was a fair inter-reader agreement for imaging signs, and moderate agreement of 0.60 for OM. The sensitivities of the penumbra sign on T1W imaging, ghost sign on T1W imaging, and ghost sign on ADC map for OM are 3.7, 9.8, and 19.5%, respectively, while their respective specificities are 98.9, 97.8, and 94.5%, respectively. All three imaging signs showed a similar (good) accuracy of 76 to 78%. Conclusion  The ghost sign on ADC can be used as an additional marker for OM and is a similarly highly specific but a more sensitive sign for OM than the conventionally used penumbra sign and ghost sign on T1W imaging. Key Points The ghost sign on ADC can be used as a helpful indicator of osteomyelitis.Across two fellowship-trained musculoskeletal readers, there was a fair inter-reader agreement for imaging signs and moderate agreement for OM.The ghost sign on ADC is a similarly highly specific but a more sensitive sign for osteomyelitis than the conventionally used penumbra sign and ghost sign on T1W imaging. All three imaging signs showed a similar (good) accuracy of 76 to 78%., Competing Interests: Conflict of Interest A.C. is a consultant of ICON Medical and TREACE Medical Concepts Inc., receives book royalties from Jaypee and Wolters, and serves as the medical advisor for ImageBiopsy Lab Inc. and receives research grants from ImageBiopsy Lab Inc. and Qure-AI. O.A. and P.P. are consultants for Image Biopsy Lab, Inc. Rest of the authors declare no conflict of interest., (Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).)

Rationale and Objectives: Physicians spend large amounts of time on protocolling imaging studies, limiting their time spent on other essential clinical tasks. Most musculoskeletal (MSK) MRI studies are performed for the evaluation of joint pain and internal derangements and usually require no intravenous contrast. Contrast-enhanced MRI studies are performed for the evaluation of infection, suspected or established tumor, and rheumatological conditions. Protocolling all MSK MRI studies takes time away from other important tasks during the workday. Routine joint MRI scans have established set of sequences, and thus, could be scheduled and performed without special protocols by the radiologists. In a large tertiary care center like ours with multiple MRI magnets, we set up a process of automated protocoling and scheduling of non-contrast joint MRI scans ordered by referring doctors. This project's purpose was to assess the effect of this newly established process of 'automatic protocoling and scheduling' of MSK MRI scans on the rate of overlooked MRI exams that may have required contrast examinations, and on the patient recall-rate to obtain follow-up post-contrast sequences for further diagnostic characterization., Methods: All MSK reports of MRIs during the last two months of the years before and after the implementation of automatic protocolling (intervention) were searched for the presence of indications related to neoplasms, infections, and rheumatological conditions. For each of the three disease categories, we determined the number of MRIs obtained with and without contrast before and after the intervention. For each matching study obtained without contrast, the patient chart was reviewed for contraindications to contrast, positive final diagnosis, whether interpreting radiologist mentioned the exam being limited by lack of contrast, and recommendations for a follow-up contrast enhanced study., Results: A total of 846 MSK MRIs were performed prior to intervention and 822 MRIs were performed afterwards. Overall, 25% of the studies were performed without contrast prior to the intervention, and 31% of studies were performed without contrast afterwards (Chi square 0.07, p-value 0.79). No report contained a recommendation for contrast enhanced follow-up study before or after the intervention., Conclusion: Automatic protocolling of routine MSK non-contrast MRI studies resulted in statistically insignificant, minimal increase in the overall number of non-contrast enhanced studies obtained for work up of neoplasms, infections, and rheumatological conditions. There was no increase in patient recall rate for additional post contrast sequences and the new process resulted in time savings to fellows and other physicians, being not distracted from other important tasks., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Oganes Ashikyan reports a relationship with Image Biopsy Lab, Inc that includes: consulting or advisory. Avneesh Chhabra reports a relationship with ICON Clinical Research LLC Warrington that includes: consulting or advisory. Avneesh Chhabra reports a relationship with TREACE Medical Concepts Inc that includes: consulting or advisory. Avneesh Chhabra reports a relationship with Image Biopsy Lab, Inc that includes: funding grants., (Copyright © 2024 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.)

Background: Magnetic resonance neurography (MRN) has an increasing role in the diagnosis and management of pudendal neuralgia, a neurogenic cause of chronic pelvic pain., Objective: The objective of this research was to determine the role of MRN in predicting improved pain outcomes following computed tomography (CT)-guided perineural injections in patients with pudendal neuralgia., Study Design: This study used a retrospective cross-sectional study design., Setting: The research was conducted at a large academic hospital., Methods: Patients: Ninety-one patients (139 injections) who received MRN and CT-guided pudendal blocks were analyzed., Intervention: A 3Tesla (T) scanner was used to evaluate the lumbosacral plexus for pudendal neuropathy. Prior to receiving a CT-guided pudendal perineural injection, patients were given pain logs and asked to record pain on a visual analog scale., Measurement: MRN findings for pudendal neuropathy were compared to the results of the CT-guided pudendal nerve blocks. Injection pain responses were categorized into 3 groups - positive block, possible positive block, and negative block.Statistical Tests: A chi-square test was used to test any association, and a Cochran-Armitage trend test was used to test any trend. Significance level was set at .05. All analyses were done in SAS Version 9.4 (SAS Institute, Inc., Cary, NC)., Results: Ninety-one patients (139 injections) who received MRN were analyzed. Of these 139 injections, 41 were considered positive (29.5%), 52 of 139 were possible positives (37.4%), and 46 of 139 were negative blocks (33.1%). Of the patients who had a positive pudendal block, no significant difference was found between the MRN result and the pudendal perineural injection response (P = .57). Women had better overall response to pudendal blocks, but this response was not associated with MRN findings (P = .34). However, positive MRN results were associated with better pain response in men (P = .005). Patients who reported bowel dysfunction also had a better response to pudendal perineural injection (P = .02)., Limitations: Some limitations include subjectivity of pain reporting, reporting consistency, absence of a control group, and the retrospective nature of the chart review., Conclusion: Pudendal perineural injections improve pain in patients with pudendal neuralgia and positive MRN results are associated with better response in men., Key Words: MRI, MRN, CT injection, pudendal neuralgia, pudendal nerve, pelvic pain, chronic pelvic pain, pudendal neuropathy.