Predictive Value of Radiographic and Magnetic Resonance Imaging Characteristics on Patient Outcomes in Confirmed Acute Osteomyelitis of the Extremities

Objective The aim of this study was to determine whether imaging characteristics on plain radiography, magnetic resonance imaging (MRI), and diffusion-weighted imaging are predictive of patient outcomes in cases of confirmed osteomyelitis (OM). Materials and Methods In this cross-sectional study, 3 experienced musculoskeletal radiologists evaluated pathologically proven cases of acute extremity OM and recorded imaging characteristics on plain radiographs, MRI, and diffusion-weighted imaging. These characteristics were then compared with the patient outcomes after a 3-year follow-up using length of stay, amputation-free survival, readmission-free survival, and overall survival using multivariate Cox regression analysis. Hazard ratio and corresponding 95% confidence intervals are reported. False discovery rate-adjusted P values were reported. Results For the 75 consecutive cases of OM in this study, multivariate Cox regression analysis adjusting for sex, race, age, body mass index, erythrocyte sedimentation rate, C-reactive protein, and white blood cell count showed no correlation among any of the recorded characteristics on imaging and patient outcomes. Despite the high sensitivity and specificity of MRI for diagnosing OM, there was no correlation between MRI characteristics and patient outcomes. Furthermore, patients with coexistent abscess of the soft tissue or bone with OM had comparable outcomes using the previously mentioned metrics of length of stay, amputation-free survival, readmission-free survival, and overall survival. Conclusion Neither radiography nor MRI features predict patient outcomes in extremity OM.