{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T16:11:13Z","timestamp":1770739873112,"version":"3.49.0"},"reference-count":32,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2022,2,1]],"date-time":"2022-02-01T00:00:00Z","timestamp":1643673600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Magnetic Resonance Imaging"],"published-print":{"date-parts":[[2022,11]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Diagnosis of osteomyelitis by imaging can be challenging. The feasibility of diffusion\u2010weighted imaging (DWI) as ancillary sequence was evaluated in this study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Purpose<\/jats:title><jats:p>To evaluate DWI for differentiation between osteomyelitis, bone marrow edema, and healthy bone on forefoot magnetic resonance imaging (MRI).<\/jats:p><\/jats:sec><jats:sec><jats:title>Study type<\/jats:title><jats:p>Prospective.<\/jats:p><\/jats:sec><jats:sec><jats:title>Subjects<\/jats:title><jats:p>A total of 60 consecutive patients undergoing forefoot MRI divided into three study groups (20 subjects each): osteomyelitis, bone marrow edema, and healthy bone.<\/jats:p><\/jats:sec><jats:sec><jats:title>Field strength\/Sequence<\/jats:title><jats:p><jats:styled-content style=\"fixed-case\">A 1.5T and 3T MRI<\/jats:styled-content> scanners; readout\u2010segmented multishot echo planar <jats:styled-content style=\"fixed-case\">DWI<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Assessment<\/jats:title><jats:p>Two independent radiologists measured apparent diffusion coefficient (ADC) values within abnormal or healthy bone.<\/jats:p><\/jats:sec><jats:sec><jats:title>Statistical Tests<\/jats:title><jats:p>ADC values were compared between groups (pairwise <jats:italic>t<\/jats:italic>\u2010test with Bonferroni\u2010Holm correction for multiple testing). Intraclass correlation coefficient (ICC) was calculated to assess inter\u2010reader agreement. Threshold ADC values were determined as the cutoffs that maximized the sum of sensitivity and specificity. Receiver operating characteristic (ROC) analysis was performed with statistical threshold of <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.05.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Inter\u2010reader agreement was 0.92 in the healthy bone group and 0.78 in both the edema and osteomyelitis groups. Average ADC values were significantly different between groups: 1432\u2009\u00b1\u2009222\u00a0\u00d7\u200910<jats:sup>\u22126<\/jats:sup>\u00a0mm<jats:sup>2<\/jats:sup>\/sec (osteomyelitis), 1071\u2009\u00b1\u2009196\u00a0\u00d7\u200910<jats:sup>\u22126<\/jats:sup>\u00a0mm<jats:sup>2<\/jats:sup>\/sec (bone marrow edema), and 277\u2009\u00b1\u200989\u00a0\u00d7\u200910<jats:sup>\u22126<\/jats:sup>\u00a0mm<jats:sup>2<\/jats:sup>\/sec (healthy bone). A threshold ADC value of 534\u00a0\u00d7\u200910<jats:sup>\u22126<\/jats:sup>\u00a0mm<jats:sup>2<\/jats:sup>\/sec distinguishes between healthy and abnormal bone with specificity and sensitivity of 100% each. For distinction between osteomyelitis and bone marrow edema, two cutoff values were determined: a 95%\u2010specificity cutoff indicating osteomyelitis (&gt;1320\u00a0\u00d7\u200910<jats:sup>\u22126<\/jats:sup>\u00a0mm<jats:sup>2<\/jats:sup>\/sec) and a 95%\u2010sensitivity cutoff indicating bone marrow edema (&lt;1155\u00a0\u00d7\u200910<jats:sup>\u22126<\/jats:sup>\u00a0mm<jats:sup>2<\/jats:sup>\/sec). Diagnostic accuracy of 95% was achieved for 73% (29\/40) of the subjects.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data Conclusion<\/jats:title><jats:p>DWI with ADC maps distinguishes between healthy and abnormal bone on forefoot MRI. Calculated cutoff values allow confirmation or exclusion of osteomyelitis in a high proportion of subjects.<\/jats:p><\/jats:sec><jats:sec><jats:title>Evidence Level<\/jats:title><jats:p>2<\/jats:p><\/jats:sec><jats:sec><jats:title>Technical Efficacy<\/jats:title><jats:p>Stage 2<\/jats:p><\/jats:sec>","DOI":"10.1002\/jmri.28091","type":"journal-article","created":{"date-parts":[[2022,2,2]],"date-time":"2022-02-02T04:22:35Z","timestamp":1643775755000},"page":"1571-1579","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Diffusion\u2010Weighted Imaging Distinguishes Between Osteomyelitis, Bone Marrow Edema, and Healthy Bone on Forefoot Magnetic Resonance Imaging"],"prefix":"10.1002","volume":"56","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9407-9554","authenticated-orcid":false,"given":"Konrad A.","family":"Kruk","sequence":"first","affiliation":[{"name":"Division of Radiology and Nuclear Medicine Kantonsspital St. Gallen  St. Gallen CH\u20109007 Switzerland"},{"name":"Faculty of Medicine University of Zurich  Zurich CH\u20108091 Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tobias J.","family":"Dietrich","sequence":"additional","affiliation":[{"name":"Division of Radiology and Nuclear Medicine Kantonsspital St. Gallen  St. Gallen CH\u20109007 Switzerland"},{"name":"Faculty of Medicine University of Zurich  Zurich CH\u20108091 Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simon","family":"Wildermuth","sequence":"additional","affiliation":[{"name":"Division of Radiology and Nuclear Medicine Kantonsspital St. Gallen  St. Gallen CH\u20109007 Switzerland"},{"name":"Faculty of Medicine University of Zurich  Zurich CH\u20108091 Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sebastian","family":"Leschka","sequence":"additional","affiliation":[{"name":"Division of Radiology and Nuclear Medicine Kantonsspital 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