Title: Magnetic Resonance Imaging for Diagnosing Foot Osteomyelitis, A Meta-analysis
Authors: Alok Kapoor, MD; Stephanie Page, MD; Michael LaValley, PhD; Daniel R. Gale, MD; David T. Felson, MD, MPH
Source: Archives of Internal Medicine. 2007; 167:125-132.
PODIATRIC RELEVANCE:
Osteomyelitis is a very common condition that is seen in the podiatric medical profession. The gold standard for diagnosing osteomyelitis is performed invasively by a bone biopsy. The most common non-invasive procedure that is currently used for diagnosing osteomyelitis is technetium Tc 99m bone scans. Other non-invasive studies used in the aid of diagnosing osteomyelitis are: plain radiography, white blood cell studies, and magnetic resonance imaging (MRI). The objective of this study was to find the diagnostic test performance of magnetic resonance imaging (MRI), and compare it to plain radiography, white blood cell studies, and technetium Tc 99m bone scans where osteomyelitis was present in the foot or ankle.
METHODS:
In this article the authors gathered information from English studies, where MRI was used to evaluate osteomyelitis in the foot or ankle. The authors reviewed information from MEDLINE (from 1966 to week of 3 of June 2006), and EMBASE (from 1980 to week 3 of June 2006). The authors used the Cochrane Methods Group to gather their data. The summary receiver operating characteristic curve analysis was used to summarize the performance of diagnostic tests. The curve analysis relies upon the calculation of the diagnostic odds ratio (DOR). The presence or absence of certain design flaws or populations was also taken into account.
RESULTS:
The results were based on sixteen studies that met the inclusion criteria. The DOR of MRI for all the studies combined was 42.1 (95% confidence interval, 14.8-119.9), with 90% specificity and 85% sensitivity. In comparing the other technological studies to MRI, the DOR was consistently better for the MRI. When comparing MRI to bone scans the DOR was (149.9 vs. 3.6- in 7 studies), plain radiographs (81.5 vs. 3.3- in 9 studies), and white blood cell studies (120.3 vs. 3.4- in 3 studies) The subsets of the studies did not affect the DOR.
COMMENTS:
The authors concluded from the information they gathered, that MRI performed much better than technetium Tc 99m bone scans, plain radiographs, and white blood cell studies in the diagnosing osteomyelitis in the foot or ankle. They concluded that MRI can be used to rule in or rule out the presence of osteomyelitis.
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Disclaimer:
Scientific Abstract Monthly postings are submitted by podiatric surgical residents. The ideas presented are not the opinions of the American College of Foot and Ankle Surgeons (ACFAS), nor are they presented as facts. ACFAS presents this information without any warranty of any kind, expressed or implied, and is not liable for its accuracy nor for any loss or damage caused by the user's reliance on information obtained in these areas.