In his 1966 monograph "Charcot joints", Sidney N. Eichenholtz (1909-2000) described "three well defined stages … in the course and development of a Charcot joint", based on plain X-rays of 68 patients. Since then, medical imaging has advanced very much: computed tomography and magnetic resonance imaging (MRI) scans exceed plain X-ray by far in detecting foot fractures and other injuries. The earliest, nondeforming, X-ray-negative inflammatory stage of the acute Charcot joint of the diabetic foot can be visualised only by use of MRI. This stage, which Eichenholtz evidently failed to recognise, will heal without significant arthropathy, if treated in time. By contrast, the stages considered by Eichenholtz inevitably result in major arthropathy and foot deformity. Hence, superseding the Eichenholtz classification is overdue. We propose an MRI-based classification comprising two severity grades (0 and 1, according to absence/presence of cortical fractures) and two stages (active/inactive, according to presence/absence of skeletal inflammation).
Amongst 1599 patients undergoing surgery for abdominal aortic aneurysm, there were 89 patients (5.6%) who showed typical features of inflammatory aneurysms of the abdominal aorta (IAAA). 37 of the 89 patients had been examined preoperatively by CT. In 73% of the cases (27/37) a correct diagnosis had been made. Localisation, width and extent of the IAAA was correctly diagnosed in all patients. Involvement of the renal arteries by the inflammatory process, the extent of thrombus and of mural calcification were accurately shown. The inflammatory tissues were typically ventral and lateral to the aorta. Frequently, there were adhesions to neighbouring structures. Aortic rupture, aortic dissection and retroperitoneal lymphoma may produce similar CT appearances; nevertheless, CT remains at present the method of choice for the diagnosis of IAAA because of its high sensitivity.
I.a. DSA of the lower limb using fine-needle-technique is an easily applied angiographic method of low radiocontrast agent consumption and a low complication rate. Essential information can be acquired preoperatively in planning far peripheral bypass anastomoses. Postoperative vascular complications can be safely assessed.
In patients suffering from diabetic osteoarthropathy, a total of 97 forefeet were evaluated concerning their bone tissue and soft tissue transformations. The most prevalent forms of demineralisation were circumscribed osteoporosis (21%) and diffuse osteoporosis (20%). Subluxations (6.2%), dislocations (2.1%), erosions (8.3%), marginal usures (11.3%) or cysts of the bone (11.3%) were seen only rarely. Extensions of the articular space (10.3%) were more prevalent than disappearances of the articular space (4.1%). The MTP (26.8%) and PIP joints (10.3%) were confirmed to be preferred localisations. A sudden loss of articular surface (25%) and a fast transition to mutilation (23.5%) show the increasing tendency of the fast transition to advanced stages of destruction by omitting the earlier stages.
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