Comparison of the diagnostic accuracy of diffusion-weighted and dynamic contrast-enhanced MRI with 18F-FDG PET/CT to differentiate osteomyelitis from Charcot neuro-osteoarthropathy in diabetic foot. Issue 132 (November 2020)

• Record Type: Journal Article
• Authors: Diez, Ana I. Garcia; Fuster, David; Morata, Laura; Torres, Ferran; Garcia, Ruben; Poggio, Daniel; Sotes, Santiago; Del Amo, Montserrat; Isern-Kebschull, Jaime; Pomes, Jaume; Soriano, Alex; Brugnara, Laura; Tomas, Xavier
• Is Part Of: European journal of radiology. Issue 132(2020)
• Publication Date: 2020-11
• Subjects: AIF arterial input function -- AUC area under the receiver operating characteristic curve -- CN Charcot neuro-osteoarthropathy -- DCE dynamic contrast-enhanced -- DFO diabetic foot osteomyelitis -- dSUVmax maximum standardized uptake value of delayed phase -- DWI diffusion-weighted imaging -- DWIr high b-value signal pathological-to-normal bone ratio on DWI -- iAUC internal area under the gadolinium curve -- ICC intraclass correlation coefficient -- Ktrans volume transfer constant -- Kep reflux rate -- MR magnetic resonance -- MRI magnetic resonance imaging -- NPV negative predictive value -- PPV positive predictive value -- RI retention index -- ROC receiver operating characteristics -- ROI region of interest -- SUVmax maximum standardized uptake value of standard phase -- TIC time-intensity curve -- Ve volume fraction of the extravascular-extracellular matrix -- 18F-FDG PET/CT 18-fluorodeoxyglucose positron emission tomography / computed tomography; Diabetic -- Foot -- Osteomyelitis -- Charcot neuro-osteoarthropathy -- Diffusion-weighted imaging -- Dynamic contrast-enhanced magnetic resonance imaging -- Positron emission tomography computed tomography; Medical radiology -- Periodicals; Radiology -- Periodicals; Radiologie médicale -- Périodiques; Medical radiology; Periodicals; 616.075705
• DOI: 10.1016/j.ejrad.2020.109299
• Languages: English
• ISSNs: 0720-048X

Abstract

Highlights: Functional MR parameters are useful for differentiation between DFO and CN. Functional MR measurements with large ROIs provide more reliable results. 18 F-FDG PET/CT showed greater diagnostic performance than functional MRI. 18 F-FDG PET/CT is a good imaging tool when nuclear medicine studies are required. Abstract: Purpose: To compare the diagnostic accuracy of diffusion-weighted imaging (DWI) and dynamic contrast-enhanced-magnetic resonance imaging (DCE-MRI) involving two region of interest (ROI) sizes with 18-fluorodeoxyglucose positron emission tomography/computed tomography ( 18 F-FDG PET/CT) to differentiate diabetic foot osteomyelitis (DFO) from Charcot neuro-osteoarthropathy (CN). Method: Thirty-one diabetic patients were included in this prospective study. Two readers independently evaluated DWI (apparent diffusion coefficient [ADC] and high-b-value signal pathological-to-normal bone ratio [DWIr]) and DCE-MRI parameters ( K trans, Kep, Ve, internal area under the gadolinium curve at 60 s [iAUC60 ] and time intensity curve [TIC]) using two different ROI sizes, and 18 F-FDG PET/CT parameters (visual assessment, SUVmax, delayed SUVmax, and percentage changes between SUVmax and delayed SUVmax ). Techniques were compared by univariate analysis using the area under the receiver operating characteristic curve [AUC]. Reliability was analyzed with Kappa and Intraclass correlation [ICC]. Results: DWIr, K trans and iAUC60 showed better diagnostic accuracy (AUC = 0.814−0.830) and reliability (ICC > 0.9) for large than for small ROIs (AUC = 0.736−0.750; ICC = 0.6 in K trans, 0.8 in DWIr and iAUC60 ). TIC showed moderate diagnostic performance (AUC = 0.739−0.761) and reliability (κ 0.7). Visual assessment of 18 F-FDG PET/CT demonstrated a significantly higher accuracy (AUC = 0.924) than MRI parameters. Semi-quantitative 18 F-FDG PET/CT parameters did not provide significant improvement over visual analysis (AUC = 0.848−0.903). Conclusion: DWIr, K trans and iAUC60 allowed reliable differentiation of DFO and CN, particularly for large ROIs. Visual assessment of 18 F-FDG PET/CT was the most accurate technique for differentiation.