New MSKI-RADS Can Help Standardize Diagnosis of Extremity Infections

Wednesday, December 4, 2024

By Melissa Silverberg

A newly developed Musculoskeletal Infection-Reporting and Data Systems (MSKI-RADS) framework can help standardize terminology and recommended management of MRI findings of extremity infections.

While many of the existing RADS systems focus on characterizing tumors and malignancies, that only accounts for a small portion of the musculoskeletal radiology world, a problem that medical student Angela He, BS, BA, studied how to address in her Tuesday presentation.

“There are many areas in musculoskeletal radiology that would benefit from the implementation of a RADS system, and this is especially true in the realm of reporting musculoskeletal infections on MRI, where current terminology used to describe imaging findings are nonspecific and inconsistent,” said He, a student at University of Texas Southwestern Medical School in Dallas. “That is why we sought to create a uniform lexicon and reporting guideline for musculoskeletal infections in the form of MSKI-RADS.”

New RADS Could Help In Clinical Decision Making

Even among radiologists, there can be some confusion related to the terminology used to describe musculoskeletal infection findings on MRI as some of the current terms used were originally created for the radiographic interpretation of osteomyelitis, He noted.

“Creating a standardized reporting system with a uniform lexicon of recommended terminology to use improves clarity, minimizes the usage of misleading terms, and allows for more confident diagnoses of musculoskeletal infections, particularly serious ones like osteomyelitis,” He said. “Ultimately, this aids in more efficient clinical decision making and better patient outcomes.”

MSKI-RADS was designed by a multidisciplinary team of eight experts at UT Southwestern and validated in a retrospective study using images of 208 patients (133 male, 75 female) with suspected extremity infections obtained between June 2015 and May 2019. The MSKI-RADS scoring system is as follows:

0, incomplete imaging
I, negative for infection
II, superficial soft-tissue infection
III, deeper soft-tissue infection
IV, possible osteomyelitis
V, highly suggestive of osteomyelitis and/or septic arthritis
VI, known osteomyelitis
NOS (not otherwise specified), nonspecific bone lesions

Researchers found that the system's overall accuracy was higher than diagnoses without using it, at 65% compared with 55%. The study results were published in Radiology along with an editorial from Mark E. Schweitzer, professor of medicine, orthopedic surgery, and radiology at Wayne State University in Detroit, MI, that called the new MSKI-RADS system “impressive” although it was developed at only one institution instead of through a more traditional multi-institutional process.

The study also highlighted the consistency of MSKI-RADS across different levels of reader experience. Twenty radiologists from 13 institutions participated in the validation, showing moderate inter-reader agreement. Notably, there was no significant correlation between reader experience and diagnostic accuracy, suggesting that MSKI-RADS can be effectively used across expertise levels.

“MSKI-RADS is a valid and reliable standardized guideline for reporting MRI findings of extremity musculoskeletal infections across various musculoskeletal fellowship-trained radiologists,” He concluded. “We believe that MSKI-RADS shows a lot of promise as an important asset with broad applicability in the field of musculoskeletal radiology and are excited to see where it will go.”

Access the presentation, “MSKI-RADS: AN MRI-Based Musculoskeletal Infection Reporting and Data System for the Diagnosis of Extremity Infections,” (T3-SSMK05-6) on demand at RSNA.org/MeetingCentral

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The RSNA 2024 Daily Bulletin is the official publication of the 110th Scientific Assembly and Annual Meeting of the Radiological Society of North America. Published online Sunday, December 1 — Friday, December 6.

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