E2144. Meta-Analysis: Investigating the Diagnostic Value-Added of Gadolinium Contrast Agents for Osteomyelitis of the Appendicular Skeleton
  1. Chase Labiste; Nova Southeastern University
  2. Evan McElroy; Nova Southeastern University
  3. Ty Subhawong; University of Miami
  4. James Banks; Nova Southeastern University
Osteomyelitis is an infection of the bone and bone marrow. Medical imaging with radiography followed by magnetic resonance imaging (MRI) with gadolinium-based contrast is the standard of care for diagnosis of osteomyelitis. The objective is to systematically review the evidence on the diagnostic accuracy of MRI with and without gadolinium-based contrast compared to MRI without contrast to diagnose osteomyelitis in the appendicular skeleton. MRI plays a critical role in the imaging evaluation of osteomyelitis, but the role of contrast-enhanced sequences remains controversial. We performed a systematic review to determine the incremental value of gadolinium-based contrast MRI in diagnosing and treating osteomyelitis in the appendicular skeleton.

Materials and Methods:
We conducted a systematic review of MRI imaging to diagnose osteomyelitis. We searched MEDLINE and EMBASE from 1990 to March 2020 using the keywords: Magnetic resonance imaging; Osteomyelitis; Infection; Gadolinium; Contrast-enhanced. The full text of all 53 eligible articles was obtained for assessment. Review articles, case reports, letters, and comments were not selected. Analytic methods were based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Evidence was evaluated using the STARD criteria for evaluation of completeness and transparency of reporting.

Four primary studies were included in the analysis compromising of 162 and 167 patients with a positive or negative diagnosis of osteomyelitis, respectively. MRI images with gadolinium contrast have a 91% (95% CI, 86%-95%) sensitivity, 87% (95% CI, 81%-92%) specificity, and 96% (standard error [SE] = 0.01) overall diagnostic accuracy for diagnosing osteomyelitis. This compares to 88% (95% CI, 82%-95%) sensitivity, 84% (95% CI, 77%-89%) specificity, and 93% (standard error [SE] = 0.01) overall diagnostic accuracy for images without gadolinium enhancement. The median score was 79% utilizing the STARD criteria. The Cohen’s weighted kappa value indicated reader agreement was considered excellent at 82.1% for the STARD criteria assessment.

There is no added value of gadolinium contrast for the diagnosis of osteomyelitis in the appendicular skeleton in children and adults; IV contrast should not be routinely administered for this purpose although it may be appropriate in a specific subset of patients.