AB1189 Role of diffusion weighted imaging in diabetic foot magnetic resonance imaging

Abstract

BackgroundDifferentiation of acute diabetic osteoarthropathy from acute osteomyelitis is one of the most challenging issues in the evaluation of diabetes related foot complications. Early differentiation between these conditions is crucial, as early management of acute diabetic osteoarthropathy could prevent permanent deformity and resultant morbidity and initiation of appropriate treatment for osteomyelitis can reduce the risk of amputations. Acute diabetic osteoarthropathy may mimic osteomyelitis clinically and at different imaging modalities. The current imaging modalities used for assessment for diabetic foot have several limitationsObjectivesevaluate the role of diffusion weighted echoplanar MR imaging in differentiation of diabetic osteoarthopathy from osteomyelitis of diabetic foot.MethodsProspective study was conducted on 37 consecutive patients with diabetic foot. They underwent diffusion weighted MR imaging of the foot using a single shot echo planar imaging with a b-factor of 0,500 and 1000 sec/mm2. The scanning parameters were: TR=10000 ms, TE=108 ms, NEX=8–16, bandwidth=125 kHz, slice thickness=4 mm. Apparent diffusion coefficient (ADC) map was reconstructed. The ADC value was calculated and correlated with surgical findings or biopsy. Statistical analysis was done.ResultsThe mean ADC value of diabetic osteoarthropathy was 0.97±0.13 × 10–3 mm2/sec and of osteomyelitis was 0.121±0.12 × 10–3 mm2/sec. There was statistically difference in mean ADC values between diabetic osteoarthtopathy and osteomyelitis (p<0.01). When apparent diffusion coefficient value of 0.77 × 10–3 mm2/sec was used as a threshold value for differentiating of diabetic osteoartrhopathy from osteomyelitis, the best result was obtained with an accuracy of 90%, sensitivity 92%, specificity 89%, positive predictive value 88% and negative predictive value of 86%.Conclusionswe concluded that apparent diffusion coefficient value is a new non-invasive imaging parameter that can be used for differentiation of diabetic osteoarthropathy from osteomyelitis. Application Diffusion weighted MR imaging can be added to routine MR imaging of diabetic foot.Disclosure of InterestNone declared