MR Imaging of the Diabetic Foot

McCarthy, Eoghan; Morrison, William B.; Zoga, Adam C.

doi:10.1016/j.mric.2016.08.005

Cited by 28 publications

(12 citation statements)

References 40 publications

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“…The diagnostic utility of T1W imaging in the evaluation of osteomyelitis associated with diabetic foot ulcers has been demonstrated (4,(8)(9)(10)(11)15). A confluent pattern with an intramedullary distribution of decreased T1 signal intensity is the most accurate primary imaging finding of osteomyelitis in the foot and a confluent pattern and intramedullary distribution almost always present together (9)(10)(11)15).…”

Section: Discussionmentioning

confidence: 99%

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Multivariate analyses of MRI findings for predicting osteomyelitis of the foot in diabetic patients

Jang

Park

et al. 2020

Acta Radiol

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Background There have been no previous magnetic resonance imaging (MRI) studies using multivariable analysis to diagnose osteomyelitis in patients with diabetic foot. Purpose To retrospectively investigate the MRI findings of osteomyelitis in patients with diabetic foot using multivariate analyses. Material and Methods From November 2015 to March 2018, 118 patients who underwent MRI of the foot to evaluate suspected osteomyelitis were included in this study. The patients were categorized into the presence or absence of osteomyelitis. The primary and secondary MRI findings were retrospectively reviewed. To identify independent predictive MRI findings, multivariate analyses with binary logistic regression and receiver operating characteristic curve analyses were performed including all 118 patients and 93 patients presenting decreased T1 signal intensity, respectively. Results T1 signal intensity, T1 marrow pattern, T1 marrow distribution, T2 signal intensity, concordance of marrow signal intensity, cortical interruption, ulcer depth, abscess, and wet gangrene were significantly different between the two groups ( P < 0.05). Multivariate analyses indicated that fluid equivalent T2 signal intensity, deep ulcer, and confluent T1 marrow pattern were major factors associated with osteomyelitis. The area under the curve of predicted probabilities for the combination of these factors was 0.799 across all 118 patients and 0.761 across 93 patients with decreased T1 signal intensity. Conclusion Confluent T1 marrow pattern is a reliable finding to suggest osteomyelitis in patients with diabetic foot. In addition, fluid equivalent T2 signal intensity and deep ulcer are important findings that may suggest osteomyelitis, irrespective of T1 signal intensity change.

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Section: Discussionmentioning

confidence: 99%

“…It has high sensitivity (90%) and specificity (83%) for the diagnosis of osteomyelitis (5)(6)(7). Furthermore, it has the added benefit of providing good anatomical definition and thus serving as appropriate preparation for surgical resection (8).…”

Section: Introductionmentioning

confidence: 99%

Multivariate analyses of MRI findings for predicting osteomyelitis of the foot in diabetic patients

Jang

Park

et al. 2020

Acta Radiol

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“…Despite both the high sensitivity and specify of MR imaging for osteomyelitis in the foot, osteoarthropathy can mimic infection on MR imaging with regards to bone marrow edematous changes following gadolinium administration therefore making differentiation difficult. The ability to differentiate between these conditions is further hampered as infection often coincides with neuropathic disease [20][21][22][23][24]. As such, advanced MR imaging techniques have been applied with regards to the investigation of CN, however, similar results were identified between dynamic contrast enhanced MR imaging and proton MR spectroscopy [23,25].…”

Section: Imagingmentioning

confidence: 99%

Untitled

2018

Int J Foot Ankle

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“…If Charcot neuroarthropathy is suspected, magnetic resonance imaging (MRI) allows detection of subtle changes in the early stages when the plain radiographic images appears normal 25. MRI also is useful to rule out osteomyelitis, especially in the presence of an ulcer, history of ulcers, elevated erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), or leukocytosis 2,5,25,45,62–69. The sensitivity and specificity are reported greater than 77% and 80% respectively in differentiating acute Charcot neuroathropathy from osteomyelitis 2,45,62–68.…”

Section: Introductionmentioning

confidence: 99%

Initial Diagnosis and Management for Acute Charcot Neuroarthropathy

Vopat

Nentwig

Chong

et al. 2018

kjm

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INTRODUCTION Charcot neuroarthropathy, also known as Charcot foot, is a complication of diabetes mellitus where there is progressive degeneration of the joints, but it potentially is devastating in its consequences. 1 It commonly affects the middle of the foot, hind-foot joints, the ankle, and forefoot joints, and it is believed to result from inflammation in the foot that becomes abnormally protracted due to the underlying neuropathy. 2-8 The prevalence of Charcot neuroarthropathy is up to 13% in individuals with diabetes. 9-11 Patients with Charcot neuroarthropathy encounter increased morbidity and decreased quality of life and mortality. 2,4,5,12,13 If there is a delay in treatment, Charcot neuroarthropathy could result in ulceration and infection which can lead to amputation of the limb. 12-16 These patients have a significant financial impact on the health care system through primary care, community care, outpatient costs, increased bed occupancy, and prolonged stays in hospital. Charcot neuroarthropathy poses many clinical challenges in its diagnosis and management. The often asymptomatic nature of the condition is very similar to ankle sprain, cellulitis, venous thrombosis, inflammatory arthritis, or gout in a healthy patient. 5,16-22 Missed diagnosis is as high as 79% which ultimately leads to a delay in treatment for an average of 29 weeks. 11,16,17,20,23-25 Charcot neuroarthropathy is caused by multiple factors, but essentially it is the result of peripheral neuropathy which is a complication associated with many diseases. 2,4,5 The underlying peripheral neuropathy can skew the pain perception the patient experiences and can mislead the clinician on their differential diagnosis of an "inflamed foot". A thorough neurological examination of the foot can uncover the underlying inflammatory and osteolytic disease process of Charcot neuroarthropathy. 2,4,11,19,26-29 Early recognition and intervention is imperative to avoid the rapid progression toward permanent foot deformity, ulceration, and the possibility of limb loss. 16,30,31 There are multiple review articles about Charcot neuroarthropathy 2,11-13,16,23,25,28,32-34 , but a lack of guidance on foot screen strategies for primary care and emergency room physicians. There is a need for a comprehensive guideline for initial diagnoses and management on foot care to advocate for increased awareness, thereby leading to earlier diagnosis and treatment by a multidisciplinary team.

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MR Imaging of the Diabetic Foot

Cited by 28 publications

References 40 publications

Multivariate analyses of MRI findings for predicting osteomyelitis of the foot in diabetic patients

Multivariate analyses of MRI findings for predicting osteomyelitis of the foot in diabetic patients

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Initial Diagnosis and Management for Acute Charcot Neuroarthropathy

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