Dynamic contrast-enhanced magnetic resonance imaging for differentiating osteomyelitis from acute neuropathic arthropathy in the complicated diabetic foot

Liao, Dan; Xie, Liqiu; Han, Yi; Du, Silin; Wang, Hansheng; Zeng, Chun; Li, Yongmei

doi:10.1007/s00256-018-2942-4

Cited by 19 publications

(20 citation statements)

References 32 publications

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“…The D (real diffusion coefficient) is also derived from the IVIM model and enables the assessment of the degree of water molecules movement without the influence of blood flow inside vessels. 50 Some authors have demonstrated that quantitative approaches may discriminate aseptic or reactive bone edema seen in Charcot foot from osteomyelitis in diabetic foot, the latter showing lower ADC values and higher transfer constants K trans and K ep values than Charcot foot 51,52 (►Fig. 9).…”

Section: Osteomyelitismentioning

confidence: 99%

The Value of Quantitative Musculoskeletal Imaging

Visser

Goergen

Klein

et al. 2020

Semin Musculoskelet Radiol

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Musculoskeletal imaging is mainly based on the subjective and qualitative analysis of imaging examinations. However, integration of quantitative assessment of imaging data could increase the value of imaging in both research and clinical practice. Some imaging modalities, such as perfusion magnetic resonance imaging (MRI), diffusion MRI, or T2 mapping, are intrinsically quantitative. But conventional morphological imaging can also be analyzed through the quantification of various parameters. The quantitative data retrieved from imaging examinations can serve as biomarkers and be used to support diagnosis, determine patient prognosis, or monitor therapy.We focus on the value, or clinical utility, of quantitative imaging in the musculoskeletal field. There is currently a trend to move from volume- to value-based payments. This review contains definitions and examines the role that quantitative imaging may play in the implementation of value-based health care. The influence of artificial intelligence on the value of quantitative musculoskeletal imaging is also discussed.

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Section: Osteomyelitismentioning

confidence: 99%

The Value of Quantitative Musculoskeletal Imaging

Visser

Goergen

Klein

et al. 2020

Semin Musculoskelet Radiol

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“…Increased white blood cell accumulation, inflammation, and higher marrow space permeability are characteristics associated with marrow edema in OM. Whereas, in neuropathic arthropathy, marrow edema tends to have lower cellularity and cell variety in comparison to OM [90]. Cortical erosion, 'ghost sign' (relative disappearance of bone on T1-weighted image as compared to T2-weighted image), 'penumbra sign' (high signal rim of abscess on T1-weighted image) are excellent MRI signs of OM versus cysts and well-defined margins of a neuropathic bone.…”

Section: Magnetic Resonancementioning

confidence: 99%

Pathophysiology and Molecular Imaging of Diabetic Foot Infections

Rubitschung

Sherwood

Crisologo

et al. 2021

IJMS

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Diabetic foot infection is the leading cause of non-traumatic lower limb amputations worldwide. In addition, diabetes mellitus and sequela of the disease are increasing in prevalence. In 2017, 9.4% of Americans were diagnosed with diabetes mellitus (DM). The growing pervasiveness and financial implications of diabetic foot infection (DFI) indicate an acute need for improved clinical assessment and treatment. Complex pathophysiology and suboptimal specificity of current non-invasive imaging modalities have made diagnosis and treatment response challenging. Current anatomical and molecular clinical imaging strategies have mainly targeted the host’s immune responses rather than the unique metabolism of the invading microorganism. Advances in imaging have the potential to reduce the impact of these problems and improve the assessment of DFI, particularly in distinguishing infection of soft tissue alone from osteomyelitis (OM). This review presents a summary of the known pathophysiology of DFI, the molecular basis of current and emerging diagnostic imaging techniques, and the mechanistic links of these imaging techniques to the pathophysiology of diabetic foot infections.

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“…A limited number of studies have used PET/CT or MRI to measure blood flow to bone for surgical indications, including infection, osteomyelitis, and nonunion. 8 – 13 However, there is limited to no access to these imaging methods in real-time in the operating room. At the present time, fluoroscopy and plain radiographs are used regularly in the operating room to visualize bones and assess fracture alignment and/or hardware placement.…”

Section: Current Paradigm and Challengesmentioning

confidence: 99%

Perspective on optical imaging for functional assessment in musculoskeletal extremity trauma surgery

et al. 2020

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. Significance: Extremity injury represents the leading cause of trauma hospitalizations among adults under the age of 65 years, and long-term impairments are often substantial. Restoring function depends, in large part, on bone and soft tissue healing. Thus, decisions around treatment strategy are based on assessment of the healing potential of injured bone and/or soft tissue. However, at the present, this assessment is based on subjective clinical clues and/or cadaveric studies without any objective measure. Optical imaging is an ideal method to solve several of these issues. Aim: The aim is to highlight the current challenges in assessing bone and tissue perfusion/viability and the potentially high impact applications for optical imaging in orthopaedic surgery. Approach: The prospective will review the current challenges faced by the orthopaedic surgeon and briefly discuss optical imaging tools that have been published. With this in mind, it will suggest key research areas that could be evolved to help make surgical assessments more objective and quantitative. Results: Orthopaedic surgical procedures should benefit from incorporation of methods to measure functional blood perfusion or tissue metabolism. The types of measurements though can vary in the depth of tissue sampled, with some being quite superficial and others sensing several millimeters into the tissue. Most of these intrasurgical imaging tools represent an ideal way to improve surgical treatment of orthopaedic injuries due to their inherent point-of-care use and their compatibility with real-time management. Conclusion: While there are several optical measurements to directly measure bone function, the choice of tools can determine also the signal strength and depth of sampling. For orthopaedic surgery, real-time data regarding bone and tissue perfusion should lead to more effective patient-specific management of common orthopaedic conditions, requiring deeper penetrance commonly seen with indocyanine green imaging. This will lower morbidity and result in decreased variability associated with how these conditions are managed.

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Dynamic contrast-enhanced magnetic resonance imaging for differentiating osteomyelitis from acute neuropathic arthropathy in the complicated diabetic foot

Abstract: Our results showed that DCE-MRI may provide reproducible parameters that can reliably differentiate osteomyelitis from acute neuropathic arthropathy.

Cited by 19 publications

References 32 publications

The Value of Quantitative Musculoskeletal Imaging

The Value of Quantitative Musculoskeletal Imaging

Pathophysiology and Molecular Imaging of Diabetic Foot Infections

Perspective on optical imaging for functional assessment in musculoskeletal extremity trauma surgery

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