Osteomyelitis of the diabetic foot: MR imaging-pathologic correlation.

Craig, Joseph G.; Amin, MB; Wu, Kao; Eyler, William R.; Holsbeeck, Marnix van; Bouffard, Jeffrey A.; Shirazi, K K

doi:10.1148/radiology.203.3.9169715

Cited by 171 publications

(96 citation statements)

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“…A study on bone histomorphology showed several pathological findings but did not describe in detail the type of inflammation seen in the 29 cases of osteomyelitis [25]. Other authors studied the correlation between bone histopathology and magnetic resonance imaging in 13 patients [26]. They described three types of osteomyelitis (21 cases) in their 57 bone specimens.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of surgical treatment of diabetic foot osteomyelitis: a series of 185 patients with histopathological confirmation of bone involvement

et al. 2008

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Aims/hypothesis We analysed the factors that determine the outcomes of surgical treatment of osteomyelitis of the foot in diabetic patients given early surgical treatment within 12 h of admission and treated with prioritisation of footsparing surgery and avoidance of amputation. Methods A consecutive series of 185 diabetic patients with foot osteomyelitis and histopathological confirmation of bone involvement were followed until healing, amputation or death. Results Probing to bone was positive in 175 cases (94.5%) and radiological signs of osteomyelitis were found in 157 cases (84.8%). Staphylococcus aureus was the organism isolated in the majority of cultures (51.3%), and in 35 cases (36.8%) it proved to be methicillin-resistant. The surgical treatment performed included 91 conservative surgical procedures, which were defined as those where no amputation of any part of the foot was undertaken (49.1%). A total of 94 patients received some degree of amputation, consisting of 79 foot-level (minor) amputations (42.4%) and 15 major amputations (8%). Five patients died during the perioperative period (2.7%). Histopathological analysis revealed 94 cases (50.8%) of acute osteomyelitis, 43 cases (23.2%) of chronic osteomyelitis, 45 cases (24.3%) of acute exacerbation of chronic osteomyelitis and three remaining cases (1.6%) designated as 'other'. The risks of failure in the case of conservative surgery were exposed bone, the presence of ischaemia and necrotising soft tissue infection. Conclusions/interpretation Conservative surgery without local or high-level amputation is successful in almost half of the cases of diabetic foot osteomyelitis. Prospective trials should be undertaken to determine the relative roles of conservative surgery versus other approaches.

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Section: Discussionmentioning

confidence: 99%

Outcomes of surgical treatment of diabetic foot osteomyelitis: a series of 185 patients with histopathological confirmation of bone involvement

et al. 2008

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“…Osteomyelitis was diagnosed when focally increased bone marrow signal on FST 2 WI ( fi g. 1 a) and focally decreased marrow signal on T 1 WI with or without cortical destruction, and focal marrow enhancement on postcontrast T 1 WI was observed ( fi g. 1 , 2 ). Normal marrow signal on T 1 WI with high signal on FST 2 WI and marrow enhancement post contrast were also considered as osteomyelitis as reported by other investigators [9,10] . Abscess was diagnosed when a well-defi ned high signal intensity collection was seen in the soft tissues on FST 2 WI with or without thick rim enhancement on post-contrast T 1 W sequences [11] .…”

Section: Mri Criteriamentioning

confidence: 99%

Evaluating Diabetic Foot Infection with Magnetic Resonance Imaging: Kuwait Experience

et al. 2005

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Objective: The aim of this study was to evaluate the capability of magnetic resonance imaging (MRI) to depict and characterize the changes seen in diabetic foot infections. Subjects and Methods: MRI studies of 29 diabetic patients with suspected foot infection were evaluated. Sagittal and transverse T₁-weighted images before and after intravenous gadolinium, and transverse fat-suppressed T₂-weighted images were performed on the affected regions. The MRI findings were compared to subsequent clinical and/or histopathological findings. Results: The MRI findings were: osteomyelitis in 14 patients, abscess in 5, cellulitis in 26, tenosynovitis in 4 and neuropathic joint in 8. Three cases were normal. Pathological confirmations were obtained in 19 patients. MRI and histological diagnosis were in concordance in 79% of osteomyelitis cases, 100% of neuropathy cases and 100% of cellulitis cases. The sensitivity and specificity of MRI in diagnosing osteomyelitis were 100 and 63%, respectively. The positive predictive and negative predictive values, and the accuracy were 79, 100 and 84%, respectively. MRI helped surgical planning for limb salvage procedures in 6 of the osteomyelitis cases and in a cellulitis case. Conclusion: The results indicate that MRI is a sensitive and accurate imaging modality for the evaluation of foot infections in diabetic patients and for planning proper treatment.

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“…Some studies recommend its routine use, (15,20) while others suggest it is unnecessary. (7,21,22) There is no conclusive evidence that intravenous contrast administration increases the accuracy of detection of osteomyelitis, although it certainly improves the evaluation of soft tissue pathology (e.g. abscesses, sinus tracts) and allows distinction between viable and nonviable soft tissue or bone.…”

Section: Mr Imaging Protocolmentioning

confidence: 99%

Magnetic resonance imaging of diabetic foot complications

Low¹,

Peh²

2015

smedj

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This pictorial review aims to illustrate the various manifestations of the diabetic foot on magnetic resonance (MR) imaging. The utility of MR imaging and its imaging features in the diagnosis of pedal osteomyelitis are illustrated. There is often difficulty encountered in distinguishing osteomyelitis from neuroarthropathy, both clinically and on imaging. By providing an accurate diagnosis based on imaging, the radiologist plays a significant role in the management of patients with complications of diabetic foot.

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Osteomyelitis of the diabetic foot: MR imaging-pathologic correlation.

Cited by 171 publications

References 0 publications

Outcomes of surgical treatment of diabetic foot osteomyelitis: a series of 185 patients with histopathological confirmation of bone involvement

Outcomes of surgical treatment of diabetic foot osteomyelitis: a series of 185 patients with histopathological confirmation of bone involvement

Evaluating Diabetic Foot Infection with Magnetic Resonance Imaging: Kuwait Experience

Magnetic resonance imaging of diabetic foot complications

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