Comparative Utility of Advanced Imaging in Detecting Upper Extremity Infections
Elizabeth G Kogan, BA1; Mark K Solarz, MD2; Hesham M Abdelfattah, MD2; Eric Perez, BS2; John Jennings, MD3; Etka Kurucan, MD2
1Lewis Katz School of Medicine at Temple University, Philadelphia, PA; 2Temple University Hospital, Philadelphia, PA; 3School of Medicine, Temple University, Philadelphia, PA
INTRODUCTION Infections of the hand are commonly treated by hand surgeons due to their surgical nature. While the diagnosis of superficial infections can often be made clinically, the diagnosis of deep infections can be challenging. Advanced imaging in the form of CT and MRI are often used to aid in the diagnosis. Our goal is to determine the sensitivity of CT and MRI in the diagnosis of hand infections.
MATERIALS & METHODS A retrospective chart review was conducted for consecutive patients admitted to a single, urban hospital between 2016 and 2021. Those over age 18 with extra-articular infections below the elbow, and who had undergone either bedside or operative incision and drainage (I&D) were identified. Only patients who had advanced imaging in the form of CT, MRI, or both were included in the study. The presence of purulence from the I&D procedures were considered the gold standard for positive infection. Sensitivities and positive predictive values (PPV) for the advanced imaging modalities were calculated. Separate analyses based on region of infection were also performed.
RESULTS 216 patients met inclusion criteria. 75 (35%) infections occurred in the forearm, 108 (50%) in the hand and wrist, and 33 (15%) in the fingers. 192 (89%) patients had a CT, 40 (19%) patients had an MRI, and 17 (8%) had both. 93% of CT and 74% of MRI utilized contrast. For those with positive purulence, CT scan had a sensitivity and PPV of 92% and 81%, respectively. MRI had a sensitivity and PPV of 94% and 83%, respectively. Analysis based on region of infection for CT showed incrementally increasing sensitivity from distal to proximal, though this did not reach statistical significance (p=0.09): 88% for finger, 92.2% for hand/wrist, and 98.1% for forearm. Further analysis between the two imaging modalities showed no difference in the sensitivity (p=1.0) or PPV (p=0.69) in detecting upper extremity infections.
CONCLUSIONS There is no significant difference in the sensitivity or PPV of CT and MRI in detecting upper extremity infections. There may be no added benefit of MRI - which is more costly, time consuming, and often difficult to obtain - in detecting infections of the upper extremity, particularly at more proximal levels.
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