Outcomes in diabetic foot ulcer patients with isolated T2 marrow signal abnormality in the underlying bone: should the diagnosis of “osteitis” be changed to “early osteomyelitis”?

Duryea, Dennis M.; Bernard, Stephanie A.; Flemming, Donald J.; Walker, E. Ronald; French, Cristy

doi:10.1007/s00256-017-2666-x

Cited by 31 publications

(29 citation statements)

References 16 publications

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“…The entity of EESC is strictly confined to magnet resonance technique. EESC corresponds to tissue vascularity (hyperemia due to fibrovascular infiltrate) at the site of an infectious or traumatic bone injury [8–15], rather than to increased interstitial fluid content (from diffusion by microvascular hyperpermeability), which is more prominent in the adjacent soft tissues. In the active-stage Charcot foot, closed subcortical trabecular microfractures (bone bruise), or cortical macrofractures are typical.…”

Section: Introductionmentioning

confidence: 99%

Follow up of MRI bone marrow edema in the treated diabetic Charcot foot – a review of patient charts

Chantelau

Antoniou

Zweck

et al. 2018

Diabetic Foot & Ankle

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Background: Ill-defined areas of water-like signal on bone magnetic resonance imaging (MRI), characterized as bone marrow edema or edema-equivalent signal-changes (EESC), is a hallmark of active-stage pedal neuro-osteoarthropathy (Charcot foot) in painless diabetic neuropathy, and is accompanied by local soft-tissue edema and hyperthermia. The longitudinal effects on EESC of treating the foot in a walking cast were elucidated by reviewing consecutive cases of a diabetic foot clinic. Study design: Retrospective observational study, chart review Material and methods: Cases with active-stage Charcot foot were considered, in whom written reports on baseline and follow-up MRI studies were available for assessment. Only cases without concomitant infection or skin ulcer were chosen, in whom both was documented, onset of symptomatic foot swelling and patient compliance with cast treatment. Results: From 1994 to 2017, 45 consecutive cases in 37 patients were retrieved, with 95 MRI follow-up studies (1–6 per case, average interval between studies 13 weeks). Decreasing EESC was documented in 66/95 (69%) follow-up studies. However, 29/95 (31%) studies revealed temporarily increasing, migrating or stagnating EESC. Conclusion: EESC on MRI disappear in response to prolonged offloading and immobilizing treatment; however, physiologic as well as pathologic fluctuations of posttraumatic EESC have to be considered when interpreting the MR images. Conventional MRI is useful for surveillance of active-stage Charcot foot recovery.

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Section: Introductionmentioning

confidence: 99%

Follow up of MRI bone marrow edema in the treated diabetic Charcot foot – a review of patient charts

Chantelau

Antoniou

Zweck

et al. 2018

Diabetic Foot & Ankle

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“…Because of its high sensitivity for the detection of osteomyelitis, MRI may overestimate the severity of infection, with results for "early osteomyelitis" often varied based on the interpretations by different radiologists. 11 A study by Duryea et al 24 suggests that in the presence of clinical evidence of infection, cases with MRI changes of "osteitis" should be treated aggressively as osteomyelitis.…”

Section: Discussionmentioning

confidence: 99%

Medical Imaging and Laboratory Analysis of Diagnostic Accuracy in 107 Consecutive Hospitalized Patients With Diabetic Foot Osteomyelitis and Partial Foot Amputations

Ramanujam

Han

Zgonis

2017

Foot & Ankle Specialist

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“…1 However, based on a recent MR imaging study in diabetic feet with surgical correlation, early osteomyelitis may be present in areas of T2 signal hyperintensity without associated abnormal low signal on T1weighted sequences without fat saturation. 60 Intraosseous and subperiosteal abscesses do not enhance. 1 They may be associated with a penumbra sign characterized by a discrete zone of transition of a relatively hyperintense signal between the intermediate to low signal intensity abscess cavity and the adjacent edematous or sclerotic bone marrow on unenhanced T1-weighted imaging that enhances on the post-Gd contrast-enhanced T1-weighted sequences.…”

Section: Computed Tomographymentioning

confidence: 98%

Imaging of Postoperative Infection at the Knee Joint

Taljanovic

Gimber

Omar

et al. 2018

Semin Musculoskelet Radiol

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Postoperative infections of the knee are uncommon but may occur with joint arthroplasties, fracture fixation, or after arthroscopic procedures. The ultimate diagnosis is made by joint aspiration or tissue sampling. Joint aspiration and tissue sampling can be performed under imaging guidance or intraoperatively. Imaging is an important adjunct to clinical and laboratory findings and should start with radiographs. Cross-sectional imaging including magnetic resonance (MR) imaging, computed tomography (CT), nuclear studies, and ultrasound (US) are frequently used if the diagnosis is in doubt and to evaluate the extent of disease. We discuss the current algorithm in the diagnosis of various postoperative infections of the knee joint. The article addresses the utility of radiography, MR imaging, CT, US, and the most commonly used nuclear studies in the diagnosis of various postoperative knee infections and the imaging appearances of these infections on each of these diagnostic modalities.

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Outcomes in diabetic foot ulcer patients with isolated T2 marrow signal abnormality in the underlying bone: should the diagnosis of “osteitis” be changed to “early osteomyelitis”?

Cited by 31 publications

References 16 publications

Follow up of MRI bone marrow edema in the treated diabetic Charcot foot – a review of patient charts

Follow up of MRI bone marrow edema in the treated diabetic Charcot foot – a review of patient charts

Medical Imaging and Laboratory Analysis of Diagnostic Accuracy in 107 Consecutive Hospitalized Patients With Diabetic Foot Osteomyelitis and Partial Foot Amputations

Imaging of Postoperative Infection at the Knee Joint

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