title: Distinguishing Osteomyelitis From Ewing Sarcoma on Radiography and MRI.
abstract: OBJECTIVE
  The purpose of this study was to determine whether clinical and imaging features can distinguish osteomyelitis from Ewing sarcoma (EWS) and to assess the accuracy of percutaneous biopsy versus open biopsy in the diagnosis of these diseases.
  
  
  METHODS
  Three radiologists reviewed the radiographs and MRI examinations of 32 subjects with osteomyelitis and 31 subjects with EWS to determine the presence of 36 imaging parameters. Information on demographic characteristics, history, physical examination findings, laboratory findings, biopsy type, and biopsy results were recorded. Individual imaging and clinical parameters and combinations of these parameters were tested for correlation with findings from histologic analysis. The diagnostic accuracy of biopsy was also determined.
  
  
  RESULTS
  On radiography, the presence of joint or metaphyseal involvement, a wide transition zone, a Codman triangle, a periosteal reaction, or a soft-tissue mass, when tested individually, was more likely to be noted in subjects with EWS (p ≤ 0.05) than in subjects with osteomyelitis. On MRI, permeative cortical involvement and soft-tissue mass were more likely in subjects with EWS (p ≤ 0.02), whereas a serpiginous tract was more likely to be seen in subjects with osteomyelitis (p = 0.04). African Americans were more likely to have osteomyelitis than EWS (p = 0). According to the results of multiple regression analysis, only ethnicity and soft-tissue mass remained statistically significant (p ≤ 0.01). The findings from 100% of open biopsies (18/18) and 58% of percutaneous biopsies (7/12) resulted in the diagnosis of osteomyelitis, whereas the findings from 88% of open biopsies (22/25) and 50% of percutaneous biopsies (3/6) resulted in a diagnosis of EWS.
  
  
  CONCLUSIONS
  Several imaging features are significantly associated with either EWS or osteomyelitis, but many features are associated with both diseases. Other than ethnicity, no clinical feature improved diagnostic accuracy. Compared with percutaneous biopsy, open biopsy provides a higher diagnostic yield but may be inconclusive, especially for cases of EWS. Our findings underscore the need for better methods of diagnosing these disease processes.
authors: 1 Department of Radiological Sciences (MS220), Division of Diagnostic Imaging, St. Jude Children's Research Hospital, 262 Danny Thomas Pl, Memphis, TN 38105.|2 Department of Radiology, University of Tennessee Health Science Center College of Medicine, Memphis, TN.
authors: M Beth
authors: MB
authors: McCarville
authors: 3 Department of Radiology, Brigham and Women's Hospital, Boston, MA.
authors: Jim Y
authors: JY
authors: Chen
authors: 1 Department of Radiological Sciences (MS220), Division of Diagnostic Imaging, St. Jude Children's Research Hospital, 262 Danny Thomas Pl, Memphis, TN 38105.
authors: Jamie L
authors: JL
authors: Coleman
authors: 4 Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN.
authors: Yimei
authors: Y
authors: Li
authors: 4 Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN.
authors: Xingyu
authors: X
authors: Li
authors: 5 Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN.|6 Department of Pediatrics, University of Tennessee Health Science Center College of Medicine, Memphis, TN.
authors: Elisabeth E
authors: EE
authors: Adderson
authors: 7 Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN.
authors: Mike D
authors: MD
authors: Neel
authors: 1 Department of Radiological Sciences (MS220), Division of Diagnostic Imaging, St. Jude Children's Research Hospital, 262 Danny Thomas Pl, Memphis, TN 38105.|2 Department of Radiology, University of Tennessee Health Science Center College of Medicine, Memphis, TN.
authors: Robert E
authors: RE
authors: Gold
authors: 1 Department of Radiological Sciences (MS220), Division of Diagnostic Imaging, St. Jude Children's Research Hospital, 262 Danny Thomas Pl, Memphis, TN 38105.|2 Department of Radiology, University of Tennessee Health Science Center College of Medicine, Memphis, TN.|6 Department of Pediatrics, University of Tennessee Health Science Center College of Medicine, Memphis, TN.
authors: Robert A
authors: RA
authors: Kaufman
mesh_terms: D000293:Adolescent; D001706:Biopsy; D001859:Bone Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D010019:Osteomyelitis / Q000175:diagnosis* / Q000000981:diagnostic imaging; D011859:Radiography; D012189:Retrospective Studies; D012512:Sarcoma, Ewing / Q000175:diagnosis* / Q000000981:diagnostic imaging; D055815:Young Adult
keywords: Ewing sarcoma; MRI; osteomyelitis; radiography