Journal club: Distinguishing osteomyelitis from ewing sarcoma on radiography and mri

M. Beth McCarville, Jim Y. Chen, Jamie L. Coleman, Yimei Li, Xingyu Li, Elisabeth E. Adderson, Mike D. Neel, Robert Gold, Robert A. Kaufman

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

OBJECTIVE. The purpose of this study was to determine whether clinical and imaging features can distinguish osteomyelitis from Ewing sarcoma (EWS) and to assess the accuracy of percutaneous biopsy versus open biopsy in the diagnosis of these diseases. MATERIALS AND METHODS. Three radiologists reviewed the radiographs and MRI examinations of 32 subjects with osteomyelitis and 31 subjects with EWS to determine the presence of 36 imaging parameters. Information on demographic characteristics, history, physical examination findings, laboratory findings, biopsy type, and biopsy results were recorded. Individual imaging and clinical parameters and combinations of these parameters were tested for correlation with findings from histologic analysis. The diagnostic accuracy of biopsy was also determined. RESULTS. On radiography, the presence of joint or metaphyseal involvement, a wide transition zone, a Codman triangle, a periosteal reaction, or a soft-tissue mass, when tested individually, was more likely to be noted in subjects with EWS (p ? 0.05) than in subjects with osteomyelitis. On MRI, permeative cortical involvement and soft-tissue mass were more likely in subjects with EWS (p ? 0.02), whereas a serpiginous tract was more likely to be seen in subjects with osteomyelitis (p = 0.04). African Americans were more likely to have osteomyelitis than EWS (p = 0). According to the results of multiple regression analysis, only ethnicity and soft-tissue mass remained statistically significant (p ? 0.01). The findings from 100% of open biopsies (18/18) and 58% of percutaneous biopsies (7/12) resulted in the diagnosis of osteomyelitis, whereas the findings from 88% of open biopsies (22/25) and 50% of percutaneous biopsies (3/6) resulted in a diagnosis of EWS. CONCLUSION. Several imaging features are significantly associated with either EWS or osteomyelitis, but many features are associated with both diseases. Other than ethnicity, no clinical feature improved diagnostic accuracy. Compared with percutaneous biopsy, open biopsy provides a higher diagnostic yield but may be inconclusive, especially for cases of EWS. Our findings underscore the need for better methods of diagnosing these disease processes.

Original languageEnglish (US)
Pages (from-to)640-651
Number of pages12
JournalAmerican Journal of Roentgenology
Volume205
Issue number3
DOIs
StatePublished - Sep 1 2015

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Ewing's Sarcoma
Osteomyelitis
Radiography
Biopsy
African Americans
Physical Examination
Joints
History
Regression Analysis
Demography

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging

Cite this

McCarville, M. B., Chen, J. Y., Coleman, J. L., Li, Y., Li, X., Adderson, E. E., ... Kaufman, R. A. (2015). Journal club: Distinguishing osteomyelitis from ewing sarcoma on radiography and mri. American Journal of Roentgenology, 205(3), 640-651. https://doi.org/10.2214/AJR.15.14341

Journal club : Distinguishing osteomyelitis from ewing sarcoma on radiography and mri. / McCarville, M. Beth; Chen, Jim Y.; Coleman, Jamie L.; Li, Yimei; Li, Xingyu; Adderson, Elisabeth E.; Neel, Mike D.; Gold, Robert; Kaufman, Robert A.

In: American Journal of Roentgenology, Vol. 205, No. 3, 01.09.2015, p. 640-651.

Research output: Contribution to journalArticle

McCarville, MB, Chen, JY, Coleman, JL, Li, Y, Li, X, Adderson, EE, Neel, MD, Gold, R & Kaufman, RA 2015, 'Journal club: Distinguishing osteomyelitis from ewing sarcoma on radiography and mri', American Journal of Roentgenology, vol. 205, no. 3, pp. 640-651. https://doi.org/10.2214/AJR.15.14341
McCarville, M. Beth ; Chen, Jim Y. ; Coleman, Jamie L. ; Li, Yimei ; Li, Xingyu ; Adderson, Elisabeth E. ; Neel, Mike D. ; Gold, Robert ; Kaufman, Robert A. / Journal club : Distinguishing osteomyelitis from ewing sarcoma on radiography and mri. In: American Journal of Roentgenology. 2015 ; Vol. 205, No. 3. pp. 640-651.
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abstract = "OBJECTIVE. The purpose of this study was to determine whether clinical and imaging features can distinguish osteomyelitis from Ewing sarcoma (EWS) and to assess the accuracy of percutaneous biopsy versus open biopsy in the diagnosis of these diseases. MATERIALS AND METHODS. Three radiologists reviewed the radiographs and MRI examinations of 32 subjects with osteomyelitis and 31 subjects with EWS to determine the presence of 36 imaging parameters. Information on demographic characteristics, history, physical examination findings, laboratory findings, biopsy type, and biopsy results were recorded. Individual imaging and clinical parameters and combinations of these parameters were tested for correlation with findings from histologic analysis. The diagnostic accuracy of biopsy was also determined. RESULTS. On radiography, the presence of joint or metaphyseal involvement, a wide transition zone, a Codman triangle, a periosteal reaction, or a soft-tissue mass, when tested individually, was more likely to be noted in subjects with EWS (p ? 0.05) than in subjects with osteomyelitis. On MRI, permeative cortical involvement and soft-tissue mass were more likely in subjects with EWS (p ? 0.02), whereas a serpiginous tract was more likely to be seen in subjects with osteomyelitis (p = 0.04). African Americans were more likely to have osteomyelitis than EWS (p = 0). According to the results of multiple regression analysis, only ethnicity and soft-tissue mass remained statistically significant (p ? 0.01). The findings from 100{\%} of open biopsies (18/18) and 58{\%} of percutaneous biopsies (7/12) resulted in the diagnosis of osteomyelitis, whereas the findings from 88{\%} of open biopsies (22/25) and 50{\%} of percutaneous biopsies (3/6) resulted in a diagnosis of EWS. CONCLUSION. Several imaging features are significantly associated with either EWS or osteomyelitis, but many features are associated with both diseases. Other than ethnicity, no clinical feature improved diagnostic accuracy. Compared with percutaneous biopsy, open biopsy provides a higher diagnostic yield but may be inconclusive, especially for cases of EWS. Our findings underscore the need for better methods of diagnosing these disease processes.",
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AU - Li, Xingyu

AU - Adderson, Elisabeth E.

AU - Neel, Mike D.

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N2 - OBJECTIVE. The purpose of this study was to determine whether clinical and imaging features can distinguish osteomyelitis from Ewing sarcoma (EWS) and to assess the accuracy of percutaneous biopsy versus open biopsy in the diagnosis of these diseases. MATERIALS AND METHODS. Three radiologists reviewed the radiographs and MRI examinations of 32 subjects with osteomyelitis and 31 subjects with EWS to determine the presence of 36 imaging parameters. Information on demographic characteristics, history, physical examination findings, laboratory findings, biopsy type, and biopsy results were recorded. Individual imaging and clinical parameters and combinations of these parameters were tested for correlation with findings from histologic analysis. The diagnostic accuracy of biopsy was also determined. RESULTS. On radiography, the presence of joint or metaphyseal involvement, a wide transition zone, a Codman triangle, a periosteal reaction, or a soft-tissue mass, when tested individually, was more likely to be noted in subjects with EWS (p ? 0.05) than in subjects with osteomyelitis. On MRI, permeative cortical involvement and soft-tissue mass were more likely in subjects with EWS (p ? 0.02), whereas a serpiginous tract was more likely to be seen in subjects with osteomyelitis (p = 0.04). African Americans were more likely to have osteomyelitis than EWS (p = 0). According to the results of multiple regression analysis, only ethnicity and soft-tissue mass remained statistically significant (p ? 0.01). The findings from 100% of open biopsies (18/18) and 58% of percutaneous biopsies (7/12) resulted in the diagnosis of osteomyelitis, whereas the findings from 88% of open biopsies (22/25) and 50% of percutaneous biopsies (3/6) resulted in a diagnosis of EWS. CONCLUSION. Several imaging features are significantly associated with either EWS or osteomyelitis, but many features are associated with both diseases. Other than ethnicity, no clinical feature improved diagnostic accuracy. Compared with percutaneous biopsy, open biopsy provides a higher diagnostic yield but may be inconclusive, especially for cases of EWS. Our findings underscore the need for better methods of diagnosing these disease processes.

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