Comparison between ZOOMit DWI and conventional DWI in the assessment of foot and ankle infection: a prospective study.

OBJECTIVE: The study aimed to compare ZOOMit diffusion-weighted imaging (DWI) MRI with conventional DWI MRI for visualizing small bones in the foot, soft tissue abscesses, and osteomyelitis. MATERIALS AND METHODS: The cohort consisted of a consecutive series of patients with potential foot and ankle infections referred for MR imaging. Patients were imaged using both conventional and ZOOMit DWI in the same setting. Blinded reads were then conducted in separate settings and independent of known clinical diagnosis by two expert radiologists. The results from the reads were compared statistically using paired t-tests and with biopsy specimen analysis, both anatomopathological and microbiological. RESULTS: There was improvement in fat suppression using ZOOMit sequence compared to conventional DWI (p = .001) with no significant difference in motion artifacts (p = .278). ZOOMit had a higher rate of concordance with pathology findings for osteomyelitis (72%, 31/43 cases) compared with conventional DWI (60%, 26/43 cases). ZOOMit also identified 46 additional small bones of the foot and ankle (405/596, 68.0%) than conventional DWI (359/596, 60.2%). Conventional DWI however exhibited a more negative contrast-to-noise ratio (CNR) than ZOOMit (p = 0.001). CONCLUSION: ZOOMit DWI improves distal extremity proton diffusion assessment and helps visualize more bones in the foot, with less image distortion and improved fat saturation at the expense of reduced CNR. This makes it a viable option for assessing lower extremity infections. CLINICAL RELEVANCE STATEMENT: This study highlights the novel utilization of ZOOMit diffusion-weighted imaging (DWI) for the assessment of lower extremity lesions compared to conventional DWI. KEY POINTS: • Distal extremity diffusion-weighted imaging (DWI) is often limited. • ZOOMit DWI displayed improved fat suppression with less motion artifacts and better visualization of the lower extremity bones than conventional DWI. • ZOOMit shows decreased contrast-to-noise ratio than conventional DWI.

Efficacy of MR Neurography of Peripheral Trigeminal Nerves: Correlation of Sunderland Grade versus Neurosensory Testing.

BACKGROUND AND PURPOSE: The current reference standard of diagnosis for peripheral trigeminal neuropathies (PTN) is clinical neurosensory testing (NST). MR neurography (MRN) is useful for PTN injury diagnosis, but it has only been studied in small case series. The aim of this study was to evaluate the agreement of Sunderland grades of nerve injury on MRN and NST by using surgical findings and final diagnoses as reference standards. MATERIALS AND METHODS: A total of 297 patient records with a chief complaint of PTN neuralgia were identified from the university database, and 70 patients with confirmed NST and MRN findings who underwent surgical nerve repair were included in the analysis. Cohen weighted kappa was used to calculate the strength of the agreement between the 3 modalities. RESULTS: There were 19 men and 51 women, with a mean age of 39.6 years and a standard deviation of 16.9 years. Most (51/70, 73%) injuries resulted from tooth extractions and implants. MRN injury grades agreed with surgical findings in 84.09% (37/44) of cases, and NST injury grades agreed with surgical findings in 74.19% (23/31) of cases. MRN and NST both showed similar agreement with surgery for grades I to III (70% and 71.43%). However, MRN showed a higher rate of agreement with surgery (88.24%) for injury grades IV and V than did NST (75%). CONCLUSIONS: MRN can objectively improve preoperative planning in patients with higher-grade nerve injuries.

Outcomes of Surgically Treated Pilon Fractures: A Comparison of Patients with and without Diabetes.

OBJECTIVES: Compare systemic complications, fracture healing related complications, and reoperation rates for pilon fractures in patients with and without diabetes. DESIGN: Retrospective cohort study. SETTING: National administrative claims database with patient records. PATIENTS: Patients from the years 2016 to 2020 with surgically treated closed or open pilon fractures. INTERVENTION: Patients with either closed or open pilon fractures with diabetes were compared to those without diabetes. Subgroup analysis was performed on diabetic patients with and without neuropathy. OUTCOMES: Postoperative systemic complications at 90 days, fracture healing complications at 90 days and 1 year, and reoperative rates at 90 days and 1 year. RESULTS: 2,654 (31.4%) patients with closed fractures and 491 (28.7%) patients with open fractures had a diagnosis of diabetes. In both open and closed fractures, we identified significantly higher rates of acute kidney injury, cardiac arrest, and surgical site infection in diabetic patients compared to non-diabetic patients. Additionally, we found significantly higher rates of below knee amputations in diabetic patients. Diabetic patients with closed fractures had significantly higher rates of wound healing related reoperations. Patients with advanced diabetic disease, as suggested by the presence of neuropathy, had higher rates of nonunions and post-traumatic arthritis. CONCLUSIONS: The data presented here provides updated estimates on complication rates in pilon fractures using large sample size. Additionally, our work identifies differences in outcomes for patients with and without diabetes following pilon fracture surgery. Our data suggests that patients with severe diabetes are prone to higher rates of healing complications and may benefit from additional therapeutic support. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.