KMID : 1144720230270020075
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Investigative Magnetic Resonance Imaging 2023 Volume.27 No. 2 p.75 ~ p.83
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Diagnosis of Infectious Spondylitis Using Non-Contrast Enhanced MRI With Axial Diffusion-Weighted Images: Comparison With Gadolinium-Enhanced MRI
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Choi Seung-Hoon
Hwang Jung-Min Lee Seung-Eun Lee So-Yeon Jung Joon-Yong
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Abstract
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Purpose : To assess the diagnostic performances of diffusion-weighted imaging (DWI)-included non-contrast magnetic resonance imaging (MRI) compared to standard contrast-enhanced MRI for infectious spondylitis.
Materials and Methods : This study involved 154 participants: a spondylitis group (n = 76) and a control group (n = 78) with Modic type 1 degeneration or recent compression fractures. Two readers independently reviewed paraspinal soft tissue signal change and abscess with 5-scale confidence scores based on two image sets: one featuring both non-contrast-enhanced MRI (NCEI) and DWI and the other consisting of NCEI and contrast-enhanced fat-suppressed T1-weighted imaging (CEFST1). The diagnostic performance of the two image sets was compared using McNemar tests for sensitivity, specificity, and area under the receiver operating characteristics (AUROC) analysis. Interobserver agreements (¥ê) for each images sets were also calculated.
Results : The sensitivity and specificity for infectious spondylitis were 90.8% and 69.2% for NCEI + DWI, 96.1% and 60.3% for NCEI + CEFST1 in reader 1, whereas it was 92.1% and 66.7% for NCEI + DWI, and 96.1% and 68.0% for NCEI + CEFST1 in reader 2. Sensitivities and specificities were not significantly different between NCEI + DWI and NCEI + CEFST1 (reader 1: p = 0.289, 0.065; reader 2: p = 0.250, > 0.999, respectively). However, the AUROC was not considerably different between the two modalities in only one reader (p = 0.306 in reader 1, p = 0.031 in reader 2). Interobserver agreement for infectious spondylitis was moderate (¥ê = 0.55) in NCEI + DWI and substantial (¥ê = 0.66) in NCEI + CEFST1.
Conclusion : Non-contrast enhanced MRI with additional DWI is as effective for diagnosing infectious spondylitis as a contrast-enhanced MRI.
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KEYWORD
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Spondylitis, Diffusion magnetic resonance imaging, Contrast media
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