MSKI-RADS: An MRI-based Musculoskeletal Infection Reporting and Data System for the Diagnosis of Extremity Infections

Avneesh Chhabra; Erin F. Alaia; Oganes Ashikyan; Philip K. Wong; Alireza Eajazi; Atul Kumar Taneja; Philip Colucci; Gitanjali Bajaj; Josephina A. Vossen; Parham Pezeshk; Claus Simpfendorfer; Fabiano N. Cardoso; Aparna Komarraju; Ty Subhawong; Tarun Pandey; Jonathan Samet; Felipe Ferreira de Souza; Kenneth S. Lee; Uma Thakur; Majid Chalian; Flavio Duarte Silva; Naveen Rajamohan; Mina Guirguis; Angela He; Karim Salhadar; Kavita Bhavan; Katherine Raspovic; Dane K. Wukich; Yin Xi; William B. Morrison

doi:10.1148/radiol.232914

MSKI-RADS: An MRI-based Musculoskeletal Infection Reporting and Data System for the Diagnosis of Extremity Infections

Avneesh Chhabra^*, Erin F. Alaia, Oganes Ashikyan, Philip K. Wong, Alireza Eajazi, Atul Kumar Taneja, Philip Colucci, Gitanjali Bajaj, Josephina A. Vossen, Parham Pezeshk, Claus Simpfendorfer, Fabiano N. Cardoso, Aparna Komarraju, Ty Subhawong, Tarun Pandey, Jonathan Samet, Felipe Ferreira de Souza, Kenneth S. Lee, Uma Thakur, Majid ChalianFlavio Duarte Silva, Naveen Rajamohan, Mina Guirguis, Angela He, Karim Salhadar, Kavita Bhavan, Katherine Raspovic, Dane K. Wukich, Yin Xi, William B. Morrison

^*Corresponding author for this work

Radiology

Research output: Contribution to journal › Article › peer-review

3 Scopus citations

Abstract

Background: Current terms used to describe the MRI findings for musculoskeletal infections are nonspecific and inconsistent. Purpose: To develop and validate an MRI-based musculoskeletal infection classification and scoring system. Materials and Methods: In this retrospective cross-sectional internal validation study, a Musculoskeletal Infection Reporting and Data System (MSKI-RADS) was designed. Adult patients with radiographs and MRI scans of suspected extremity infections with a known reference standard obtained between June 2015 and May 2019 were included. The scoring categories were as follows: 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. Interreader agreement for 20 radiologists from 13 institutions (intraclass correlation coefficient [ICC]) and true-positive rates of MSKI-RADS were calculated and the accuracy of final diagnoses rendered by the readers was compared using generalized estimating equations for clustered data. Results: Among paired radiographs and MRI scans from 208 patients (133 male, 75 female; mean age, 55 years ± 13 [SD]), 20 were category I; 34, II; 35, III; 30, IV; 35, V; 18, VI; and 36, NOS. Moderate interreader agreement was observed among the 20 readers (ICC, 0.70; 95% CI: 0.66, 0.75). There was no evidence of correlation between reader experience and overall accuracy (P = .94). The highest true-positive rate was for MSKI-RADS I and NOS at 88.7% (95% CI: 84.6, 91.7). The true-positive rate was 73% (95% CI: 63, 80) for MSKI-RADS V. Overall reader accuracy using MSKI-RADS across all patients was 65% ± 5, higher than final reader diagnoses at 55% ± 7 (P < .001). Conclusion: MSKI-RADS is a valid system for standardized terminology and recommended management of imaging findings of peripheral extremity infections across various musculoskeletal-fellowship-trained reader experience levels.

Original language	English (US)
Article number	e232914
Journal	Radiology
Volume	312
Issue number	2
DOIs	https://doi.org/10.1148/radiol.232914
State	Published - Aug 2024

Funding

Disclosures of conflicts of interest: A.C. Grants or contracts from IBL, Qure, AI; royalties or licenses from Wolters, Jaypee; consulting fees from ICON Medical TREACE Medical Concepts; payment or honoraria for lectures from TMC Academy; support for attending meetings and/or travel from IBL; participation on a Data Safety Monitoring Board or Advisory Board from IBL. E.F.A. No relevant relationships. O.A. Consultant for Image Biopsy Lab and department received grant for a commercial research study. P.K.W. No relevant relationships. A.E. No relevant relationships. A.K.T. No relevant relationships. P.C. No relevant relationships. G.B. No relevant relationships. J.A.V. No relevant relationships. P.P. No relevant relationships. C.S. No relevant relationships. F.N.C. No relevant relationships. A.K. Patents planned, issued, or pending from Beth Israel Deaconess Medical Center, Harvard Medical School. T.S. No relevant relationships. T.P. No relevant relationships. J.S. No relevant relationships. F.F.d.S. No relevant relationships. K.S.L.Grants or contract from National Football Leagues and royalties from Elsevier. U.T. No relevant relationships. M.C. RSNA Research and Scholar Grant Boeing Technology Development Grant and Honorarium from Elsevier. F.D.S. No relevant relationships. N.R. No relevant relationships. M.G. No relevant relationships. A.H. No relevant relationships. K.S. No relevant relationships. K.B. No relevant relationships. K.R. No relevant relationships. D.K.W. Royalties from Arthrex; consulting fees from Advanced Oxygen Therapy; President, International Association of Diabetic Foot Surgeons. Y.X. Patents planned, issued, or pending from UT Southwestern Medical Center. W.B.M. Patents planned, issued, or pending from Thomas Jefferson University Hospital.

ASJC Scopus subject areas

Radiology Nuclear Medicine and imaging

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10.1148/radiol.232914

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Chhabra, A., Alaia, E. F., Ashikyan, O., Wong, P. K., Eajazi, A., Taneja, A. K., Colucci, P., Bajaj, G., Vossen, J. A., Pezeshk, P., Simpfendorfer, C., Cardoso, F. N., Komarraju, A., Subhawong, T., Pandey, T., Samet, J., de Souza, F. F., Lee, K. S., Thakur, U., ... Morrison, W. B. (2024). MSKI-RADS: An MRI-based Musculoskeletal Infection Reporting and Data System for the Diagnosis of Extremity Infections. Radiology, 312(2), Article e232914. https://doi.org/10.1148/radiol.232914

@article{7772fcea27984a02bd6a4d31b374b71e,

title = "MSKI-RADS: An MRI-based Musculoskeletal Infection Reporting and Data System for the Diagnosis of Extremity Infections",

abstract = "Background: Current terms used to describe the MRI findings for musculoskeletal infections are nonspecific and inconsistent. Purpose: To develop and validate an MRI-based musculoskeletal infection classification and scoring system. Materials and Methods: In this retrospective cross-sectional internal validation study, a Musculoskeletal Infection Reporting and Data System (MSKI-RADS) was designed. Adult patients with radiographs and MRI scans of suspected extremity infections with a known reference standard obtained between June 2015 and May 2019 were included. The scoring categories were as follows: 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. Interreader agreement for 20 radiologists from 13 institutions (intraclass correlation coefficient [ICC]) and true-positive rates of MSKI-RADS were calculated and the accuracy of final diagnoses rendered by the readers was compared using generalized estimating equations for clustered data. Results: Among paired radiographs and MRI scans from 208 patients (133 male, 75 female; mean age, 55 years ± 13 [SD]), 20 were category I; 34, II; 35, III; 30, IV; 35, V; 18, VI; and 36, NOS. Moderate interreader agreement was observed among the 20 readers (ICC, 0.70; 95\% CI: 0.66, 0.75). There was no evidence of correlation between reader experience and overall accuracy (P = .94). The highest true-positive rate was for MSKI-RADS I and NOS at 88.7\% (95\% CI: 84.6, 91.7). The true-positive rate was 73\% (95\% CI: 63, 80) for MSKI-RADS V. Overall reader accuracy using MSKI-RADS across all patients was 65\% ± 5, higher than final reader diagnoses at 55\% ± 7 (P < .001). Conclusion: MSKI-RADS is a valid system for standardized terminology and recommended management of imaging findings of peripheral extremity infections across various musculoskeletal-fellowship-trained reader experience levels.",

author = "Avneesh Chhabra and Alaia, \{Erin F.\} and Oganes Ashikyan and Wong, \{Philip K.\} and Alireza Eajazi and Taneja, \{Atul Kumar\} and Philip Colucci and Gitanjali Bajaj and Vossen, \{Josephina A.\} and Parham Pezeshk and Claus Simpfendorfer and Cardoso, \{Fabiano N.\} and Aparna Komarraju and Ty Subhawong and Tarun Pandey and Jonathan Samet and \{de Souza\}, \{Felipe Ferreira\} and Lee, \{Kenneth S.\} and Uma Thakur and Majid Chalian and Silva, \{Flavio Duarte\} and Naveen Rajamohan and Mina Guirguis and Angela He and Karim Salhadar and Kavita Bhavan and Katherine Raspovic and Wukich, \{Dane K.\} and Yin Xi and Morrison, \{William B.\}",

note = "Publisher Copyright: {\textcopyright} RSNA, 2024.",

year = "2024",

month = aug,

doi = "10.1148/radiol.232914",

language = "English (US)",

volume = "312",

journal = "Radiology",

issn = "0033-8419",

publisher = "Radiological Society of North America Inc.",

number = "2",

}

Chhabra, A, Alaia, EF, Ashikyan, O, Wong, PK, Eajazi, A, Taneja, AK, Colucci, P, Bajaj, G, Vossen, JA, Pezeshk, P, Simpfendorfer, C, Cardoso, FN, Komarraju, A, Subhawong, T, Pandey, T, Samet, J, de Souza, FF, Lee, KS, Thakur, U, Chalian, M, Silva, FD, Rajamohan, N, Guirguis, M, He, A, Salhadar, K, Bhavan, K, Raspovic, K, Wukich, DK, Xi, Y & Morrison, WB 2024, 'MSKI-RADS: An MRI-based Musculoskeletal Infection Reporting and Data System for the Diagnosis of Extremity Infections', Radiology, vol. 312, no. 2, e232914. https://doi.org/10.1148/radiol.232914

TY - JOUR

T1 - MSKI-RADS

T2 - An MRI-based Musculoskeletal Infection Reporting and Data System for the Diagnosis of Extremity Infections

AU - Chhabra, Avneesh

AU - Alaia, Erin F.

AU - Ashikyan, Oganes

AU - Wong, Philip K.

AU - Eajazi, Alireza

AU - Taneja, Atul Kumar

AU - Colucci, Philip

AU - Bajaj, Gitanjali

AU - Vossen, Josephina A.

AU - Pezeshk, Parham

AU - Simpfendorfer, Claus

AU - Cardoso, Fabiano N.

AU - Komarraju, Aparna

AU - Subhawong, Ty

AU - Pandey, Tarun

AU - Samet, Jonathan

AU - de Souza, Felipe Ferreira

AU - Lee, Kenneth S.

AU - Thakur, Uma

AU - Chalian, Majid

AU - Silva, Flavio Duarte

AU - Rajamohan, Naveen

AU - Guirguis, Mina

AU - He, Angela

AU - Salhadar, Karim

AU - Bhavan, Kavita

AU - Raspovic, Katherine

AU - Wukich, Dane K.

AU - Xi, Yin

AU - Morrison, William B.

PY - 2024/8

Y1 - 2024/8

N2 - Background: Current terms used to describe the MRI findings for musculoskeletal infections are nonspecific and inconsistent. Purpose: To develop and validate an MRI-based musculoskeletal infection classification and scoring system. Materials and Methods: In this retrospective cross-sectional internal validation study, a Musculoskeletal Infection Reporting and Data System (MSKI-RADS) was designed. Adult patients with radiographs and MRI scans of suspected extremity infections with a known reference standard obtained between June 2015 and May 2019 were included. The scoring categories were as follows: 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. Interreader agreement for 20 radiologists from 13 institutions (intraclass correlation coefficient [ICC]) and true-positive rates of MSKI-RADS were calculated and the accuracy of final diagnoses rendered by the readers was compared using generalized estimating equations for clustered data. Results: Among paired radiographs and MRI scans from 208 patients (133 male, 75 female; mean age, 55 years ± 13 [SD]), 20 were category I; 34, II; 35, III; 30, IV; 35, V; 18, VI; and 36, NOS. Moderate interreader agreement was observed among the 20 readers (ICC, 0.70; 95% CI: 0.66, 0.75). There was no evidence of correlation between reader experience and overall accuracy (P = .94). The highest true-positive rate was for MSKI-RADS I and NOS at 88.7% (95% CI: 84.6, 91.7). The true-positive rate was 73% (95% CI: 63, 80) for MSKI-RADS V. Overall reader accuracy using MSKI-RADS across all patients was 65% ± 5, higher than final reader diagnoses at 55% ± 7 (P < .001). Conclusion: MSKI-RADS is a valid system for standardized terminology and recommended management of imaging findings of peripheral extremity infections across various musculoskeletal-fellowship-trained reader experience levels.

AB - Background: Current terms used to describe the MRI findings for musculoskeletal infections are nonspecific and inconsistent. Purpose: To develop and validate an MRI-based musculoskeletal infection classification and scoring system. Materials and Methods: In this retrospective cross-sectional internal validation study, a Musculoskeletal Infection Reporting and Data System (MSKI-RADS) was designed. Adult patients with radiographs and MRI scans of suspected extremity infections with a known reference standard obtained between June 2015 and May 2019 were included. The scoring categories were as follows: 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. Interreader agreement for 20 radiologists from 13 institutions (intraclass correlation coefficient [ICC]) and true-positive rates of MSKI-RADS were calculated and the accuracy of final diagnoses rendered by the readers was compared using generalized estimating equations for clustered data. Results: Among paired radiographs and MRI scans from 208 patients (133 male, 75 female; mean age, 55 years ± 13 [SD]), 20 were category I; 34, II; 35, III; 30, IV; 35, V; 18, VI; and 36, NOS. Moderate interreader agreement was observed among the 20 readers (ICC, 0.70; 95% CI: 0.66, 0.75). There was no evidence of correlation between reader experience and overall accuracy (P = .94). The highest true-positive rate was for MSKI-RADS I and NOS at 88.7% (95% CI: 84.6, 91.7). The true-positive rate was 73% (95% CI: 63, 80) for MSKI-RADS V. Overall reader accuracy using MSKI-RADS across all patients was 65% ± 5, higher than final reader diagnoses at 55% ± 7 (P < .001). Conclusion: MSKI-RADS is a valid system for standardized terminology and recommended management of imaging findings of peripheral extremity infections across various musculoskeletal-fellowship-trained reader experience levels.

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DO - 10.1148/radiol.232914

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JO - Radiology

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ER -

MSKI-RADS: An MRI-based Musculoskeletal Infection Reporting and Data System for the Diagnosis of Extremity Infections

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