A NOVEL MRI-based Musculoskeletal Infection Reporting and Data System (MSKI-RADS) has been developed to standardise the terminology and management of imaging findings related to peripheral extremity infections. This innovation addresses the current issue of nonspecific and inconsistent terms used in the description of MRI findings for musculoskeletal infections.
The MSKI-RADS was designed and validated through a retrospective cross-sectional study involving 208 patients (133 male, 75 female) with suspected extremity infections. The study spanned from June 2015–May 2019 and included patients who had undergone both radiographs and MRI scans. The scoring system included the following categories: 0, incomplete imaging; I, negative for infection; II, superficial soft-tissue infection; III, deeper soft-tissue infection; IV, possible osteomyelitis (OM); V, highly suggestive of OM and/or septic arthritis; VI, known OM; and NOS (not otherwise specified), nonspecific bone lesions.
Results from the study showed that the MSKI-RADS system significantly improved diagnostic accuracy. The overall accuracy of diagnoses using MSKI-RADS was 65±5%, compared to 55±7% with the traditional method (P<0.001). The highest true-positive rates were observed in MSKI-RADS categories I (negative for infection) and NOS, both at 88.7%. Conversely, the true-positive rate for category V (highly suggestive of osteomyelitis or septic arthritis) was 73%.
The study also highlighted the consistency of MSKI-RADS across different levels of reader experience. Twenty radiologists from 13 institutions participated in the validation, showing moderate inter-reader agreement with an intraclass correlation coefficient of 0.70. Notably, there was no significant correlation between reader experience and diagnostic accuracy (P=0.94), suggesting that MSKI-RADS can be effectively used across various expertise levels.
In conclusion, MSKI-RADS offers a reliable and standardised approach to diagnosing peripheral extremity infections, enhancing both accuracy and consistency in medical imaging.
Ada Enesco, EMJ
Reference
Chhabra A et al. MSKI-RADS: an MRI-based musculoskeletal infection reporting and data system for the diagnosis of extremity infections. Radiology. 2024;312(2):e232914.
