Interobserver Agreement of Magnetic Resonance Imaging Signs of Osteomyelitis in Pelvic Pressure Ulcers in Patients With Spinal Cord Injury

Abstract Objective To examine the interobserver reliability of magnetic resonance imaging (MRI) signs of osteomyelitis in complex chronic pressure ulcers in patients with spinal cord injury (SCI). Design Retrospective review study. Setting Specialist SCI rehabilitation center. Participants Adult patients with SCI and pressure ulceration investigated with MRI. Interventions Analysis of MRI examinations and clinical records collected over a 4-year period. Images were independently assessed by 2 experienced radiologists for osteomyelitis based on assigned predictive indicators including cortical bone erosion, soft tissue edema, deep collections, heterotopic new bone, hip effusion, and abnormal signal change of the marrow. Main Outcome Measures Interobserver agreement for indicative MRI signs of osteomyelitis in complex pressure ulcers. Results Thirty-seven patients underwent 41 MRI scans. Concordance for marrow edema was 71% on both short tau inversion recovery and T1-weighted sequences, and for cortical erosion was 85%. Conclusions For the assessment of pelvic osteomyelitis related to pressure ulcers, the T1-weighted MRI signal for marrow edema and cortical erosion has strong interobserver agreement.