{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T19:15:13Z","timestamp":1787166913653,"version":"build-2736575974"},"reference-count":26,"publisher":"Georg Thieme Verlag KG","issue":"01","license":[{"start":{"date-parts":[[2024,8,26]],"date-time":"2024-08-26T00:00:00Z","timestamp":1724630400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Indian J Radiol Imaging"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:p>Objective\u2003The aim of this study was to determine the sensitivity and specificity and inter-reader reliability of previously known \u201cghost sign\u201d and \u201cpenumbra sign\u201d on T1-weighted (T1W) imaging and \u201cghost sign\u201d on apparent diffusion coefficient (ADC) map in osteomyelitis (OM) of the extremities.<\/jats:p>\n                  <jats:p>Materials and Methods\u2003In this cross-sectional retrospective study, two fellowship-trained musculoskeletal readers blinded to final diagnosis of OM versus no OM were asked to report the penumbra sign and ghost sign on T1W images and ghost sign on ADC map, as well as diagnosis of OM. Cohen's kappa was used. Diagnostic performance measures including sensitivity, specificity, and accuracy were calculated.<\/jats:p>\n                  <jats:p>Results\u2003A sample of 178 magnetic resonance imaging (MRI) scans of pathology-proven cases were included in this study, with 41 being positive for OM and 137 being negative for OM. There was a fair inter-reader agreement for imaging signs, and moderate agreement of 0.60 for OM. The sensitivities of the penumbra sign on T1W imaging, ghost sign on T1W imaging, and ghost sign on ADC map for OM are 3.7, 9.8, and 19.5%, respectively, while their respective specificities are 98.9, 97.8, and 94.5%, respectively. All three imaging signs showed a similar (good) accuracy of 76 to 78%.<\/jats:p>\n                  <jats:p>Conclusion\u2003The ghost sign on ADC can be used as an additional marker for OM and is a similarly highly specific but a more sensitive sign for OM than the conventionally used penumbra sign and ghost sign on T1W imaging.<\/jats:p>\n                  <jats:p>Key Points<\/jats:p>","DOI":"10.1055\/s-0044-1789231","type":"journal-article","created":{"date-parts":[[2024,8,26]],"date-time":"2024-08-26T19:42:18Z","timestamp":1724701338000},"page":"081-087","source":"Crossref","is-referenced-by-count":5,"title":["Ghost Sign on Diffusion-Weighted Imaging Generated Apparent Diffusion Coefficient Map: Additional MRI Diagnostic Marker for Extremity Osteomyelitis"],"prefix":"10.1055","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2061-219X","authenticated-orcid":false,"given":"Angela","family":"He","sequence":"additional","affiliation":[{"name":"Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mina","family":"Guirguis","sequence":"additional","affiliation":[{"name":"Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Flavio Duarte","family":"Silva","sequence":"additional","affiliation":[{"name":"Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oganes","family":"Ashikyan","sequence":"additional","affiliation":[{"name":"Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Parham","family":"Pezeshk","sequence":"additional","affiliation":[{"name":"Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naveen","family":"Rajamohan","sequence":"additional","affiliation":[{"name":"Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karim","family":"Salhadar","sequence":"additional","affiliation":[{"name":"Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yin","family":"Xi","sequence":"additional","affiliation":[{"name":"Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Avneesh","family":"Chhabra","sequence":"additional","affiliation":[{"name":"Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, United States"},{"name":"Department of Orthopedic Surgery, UT Southwestern Medical Center, Dallas, Texas, United States"},{"name":"Department of Radiology, Johns Hopkins University, Maryland, United States"},{"name":"Department of Radiology, Walton Centre for Neuroscience, Liverpool, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2024,8,26]]},"reference":[{"issue":"12","key":"ref1","doi-asserted-by":"crossref","first-page":"2319","DOI":"10.1007\/s00256-021-03807-7","article-title":"MRI nomenclature for musculoskeletal infection","volume":"50","author":"E F Alaia","year":"2021","journal-title":"Skeletal Radiol"},{"issue":"01","key":"ref2","doi-asserted-by":"crossref","first-page":"9","DOI":"10.3201\/eid0501.990102","article-title":"The economic impact of Staphylococcus aureus infection in New York City hospitals","volume":"5","author":"R J Rubin","year":"1999","journal-title":"Emerg Infect Dis"},{"issue":"10","key":"ref3","doi-asserted-by":"crossref","first-page":"837","DOI":"10.2106\/JBJS.N.01350","article-title":"Trends in the epidemiology of osteomyelitis: a population-based study, 1969 to 2009","volume":"97","author":"H M Kremers","year":"2015","journal-title":"J Bone Joint Surg Am"},{"issue":"03","key":"ref4","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1080\/14737167.2019.1567337","article-title":"Current health and economic burden of chronic diabetic osteomyelitis","volume":"19","author":"T Geraghty","year":"2019","journal-title":"Expert Rev Pharmacoecon Outcomes Res"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"S326","DOI":"10.1016\/j.jacr.2017.02.008","article-title":"ACR Appropriateness Criteria\u00ae suspected osteomyelitis, septic arthritis, or soft tissue infection (excluding spine and diabetic foot)","volume":"14","author":"F D Beaman","year":"2017","journal-title":"J Am Coll Radiol"},{"issue":"09","key":"ref6","first-page":"1027","article-title":"Diagnosis and management of osteomyelitis","volume":"84","author":"J Hatzenbuehler","year":"2011","journal-title":"Am Fam Physician"},{"issue":"02","key":"ref7","doi-asserted-by":"crossref","first-page":"184","DOI":"10.21037\/qims.2016.04.01","article-title":"The imaging of osteomyelitis","volume":"6","author":"Y J Lee","year":"2016","journal-title":"Quant Imaging Med Surg"},{"issue":"08","key":"ref8","doi-asserted-by":"crossref","first-page":"530","DOI":"10.4329\/wjr.v6.i8.530","article-title":"Role of MRI in the diagnosis and treatment of osteomyelitis in pediatric patients","volume":"6","author":"B S Pugmire","year":"2014","journal-title":"World J Radiol"},{"issue":"01","key":"ref9","doi-asserted-by":"crossref","first-page":"414","DOI":"10.1007\/s00330-016-4372-9","article-title":"Role of diffusion weighted imaging in musculoskeletal infections: current perspectives","volume":"27","author":"Y Kumar","year":"2017","journal-title":"Eur Radiol"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"S440","DOI":"10.1016\/j.jacr.2019.05.027","article-title":"ACR Appropriateness Criteria\u00ae suspected osteomyelitis of the foot in patients with diabetes mellitus","volume":"16","author":"E A Walker","year":"2019","journal-title":"J Am Coll Radiol"},{"issue":"01","key":"ref11","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/S0033-8389(03)00163-5","article-title":"MR imaging of the diabetic foot","volume":"42","author":"M E Schweitzer","year":"2004","journal-title":"Radiol Clin North Am"},{"issue":"03","key":"ref12","doi-asserted-by":"crossref","first-page":"723","DOI":"10.1148\/rg.303095111","article-title":"Use of MR imaging in diagnosing diabetes-related pedal osteomyelitis","volume":"30","author":"A Donovan","year":"2010","journal-title":"Radiographics"},{"issue":"08","key":"ref13","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1016\/S0009-9260(98)80150-5","article-title":"The \u201cpenumbra sign\u201d on T1-weighted MR imaging in subacute osteomyelitis: frequency, cause and significance","volume":"53","author":"A C Grey","year":"1998","journal-title":"Clin Radiol"},{"issue":"05","key":"ref14","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1007\/s00256-006-0267-1","article-title":"The \u201cpenumbra sign\u201d on T1-weighted MRI for differentiating musculoskeletal infection from tumour","volume":"36","author":"B McGuinness","year":"2007","journal-title":"Skeletal Radiol"},{"issue":"03","key":"ref15","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1007\/s00256-010-0986-1","article-title":"MR imaging of skeletal soft tissue infection: utility of diffusion-weighted imaging in detecting abscess formation","volume":"40","author":"S Harish","year":"2011","journal-title":"Skeletal Radiol"},{"issue":"03","key":"ref16","doi-asserted-by":"crossref","first-page":"490","DOI":"10.1016\/j.ejrad.2009.08.025","article-title":"The diagnostic value of diffusion-weighted magnetic resonance imaging in soft tissue abscesses","volume":"77","author":"O Unal","year":"2011","journal-title":"Eur J Radiol"},{"issue":"01","key":"ref17","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1002\/jmri.25743","article-title":"Detection of soft-tissue abscess: comparison of diffusion-weighted imaging to contrast-enhanced MRI","volume":"47","author":"C W Chun","year":"2018","journal-title":"J Magn Reson Imaging"},{"issue":"01","key":"ref18","first-page":"20210077","article-title":"Diffusion-weighted MR imaging of musculoskeletal tissues: incremental role over conventional MR imaging in bone, soft tissue, and nerve lesions","volume":"4","author":"M Guirguis","year":"2022","journal-title":"BJR Open"},{"issue":"01","key":"ref19","doi-asserted-by":"crossref","first-page":"23","DOI":"10.20982\/tqmp.08.1.p023","article-title":"Computing inter-rater reliability for observational data: an overview and tutorial","volume":"8","author":"K A Hallgren","year":"2012","journal-title":"Tutor Quant Methods Psychol"},{"issue":"09","key":"ref20","doi-asserted-by":"crossref","first-page":"1669","DOI":"10.1007\/s00256-023-04331-6","article-title":"Incremental value of diffusion weighted imaging over conventional MRI for the diagnosis of osteomyelitis of extremities","volume":"52","author":"M Guirguis","year":"2023","journal-title":"Skeletal Radiol"},{"issue":"06","key":"ref21","doi-asserted-by":"crossref","first-page":"1091","DOI":"10.1016\/j.ejrad.2015.02.019","article-title":"Differentiation of benign and malignant skeletal lesions with quantitative diffusion weighted MRI at 3T","volume":"84","author":"S Ahlawat","year":"2015","journal-title":"Eur J Radiol"},{"issue":"03","key":"ref22","first-page":"496","article-title":"Diffusion-weighted imaging in a patient with vertebral and epidural abscesses","volume":"23","author":"J D Eastwood","year":"2002","journal-title":"Am J Neuroradiol"},{"issue":"02","key":"ref23","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1002\/jmri.28870","article-title":"Applications of diffusion-weighted MRI to the musculoskeletal system","volume":"59","author":"J G Raya","year":"2024","journal-title":"J Magn Reson Imaging"},{"issue":"05","key":"ref24","doi-asserted-by":"crossref","first-page":"1571","DOI":"10.1002\/jmri.28091","article-title":"Diffusion-weighted imaging distinguishes between osteomyelitis, bone marrow edema, and healthy bone on forefoot magnetic resonance imaging","volume":"56","author":"K A Kruk","year":"2022","journal-title":"J Magn Reson Imaging"},{"issue":"09","key":"ref25","doi-asserted-by":"crossref","first-page":"1647","DOI":"10.3390\/diagnostics13091647","article-title":"Pitfalls of diffusion-weighted imaging: clinical utility of T2 shine-through and T2 black-out for musculoskeletal diseases","volume":"13","author":"Y Kim","year":"2023","journal-title":"Diagnostics (Basel)"},{"issue":"10","key":"ref26","doi-asserted-by":"crossref","first-page":"1979","DOI":"10.1007\/s00256-023-04518-x","article-title":"How to do and evaluate DWI and DCE-MRI sequences for diabetic foot assessment","volume":"53","author":"T Mart\u00edn-Noguerol","year":"2024","journal-title":"Skeletal Radiol"}],"container-title":["Indian Journal of Radiology and Imaging"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0044-1789231.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,12,17]],"date-time":"2024-12-17T18:49:05Z","timestamp":1734461345000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0044-1789231"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,26]]},"references-count":26,"journal-issue":{"issue":"01","published-online":{"date-parts":[[2024,12,17]]},"published-print":{"date-parts":[[2025,1]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0044-1789231","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0971-3026","1998-3808"],"issn-type":[{"value":"0971-3026","type":"print"},{"value":"1998-3808","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,8,26]]}}}