Role of magnetic resonance imaging in the evaluation of diabetic foot with suspected osteomyelitis

Rozzanigo, Umberto; Tagliani, A.; Vittorini, Enrico; Pacchioni, R; Brivio, L. Renzi; Caudana, Roberto

doi:10.1007/s11547-008-0337-7

Cited by 37 publications

(11 citation statements)

References 20 publications

(45 reference statements)

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“…On the TIC graph, horizontal axis = time in seconds, vertical axis = contrast material concentration in millimoles per liter, AIF = arterial input function, NA = neuropathic arthropathy, OM = osteomyelitis. the presence of inflammatory hyperaemia, and it is challenging to depict pedal arteries without venous contamination (50). New sequences, such as 4D MR angiography, allow dynamic evaluation of contrast bolus, better differentiation of arteries from veins, and improved selection of potential vessels for bypassing in diabetic patients (9).…”

Section: Mr Angiographymentioning

confidence: 99%

Advanced MR Imaging Techniques for Differentiation of Neuropathic Arthropathy and Osteomyelitis in the Diabetic Foot

et al. 2017

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Diagnosis and treatment of foot disease in patients with diabetes is a common clinical-radiologic challenge, particularly the differentiation of neuropathic arthropathy from osteomyelitis. Conventional clinical tests and imaging techniques have limited accuracy for evaluation of the diabetic foot. The introduction of morphologic magnetic resonance (MR) imaging in these patients has provided a qualitative leap in diagnosis. The characteristics of soft-tissue and bone marrow edema and their patterns of distribution throughout the foot allow discrimination between both entities. However, in certain scenarios, the application of MR imaging to this problem is limited because of overlapping features between the two and the coexistence of infection and neuropathic changes. Recent technical advances in MR imaging sequences have increased the capability to add functional quantitative information to structural information. Diffusion-weighted imaging is useful to determine the presence and extension of osteomyelitis. Dynamic contrast-enhanced MR imaging may help to detect differences between the vascularization patterns of neuropathic arthropathy and osteomyelitis. MR angiography (with or without contrast material) is used in clinical practice to identify candidate distal vessels for revascularization. MR neurography, and especially diffusion-tensor imaging, provides quantitative information about neural damage. These new sequences may help in assessment of the different pathophysiologic conditions that occur in the diabetic foot. The physical basis of these techniques, their limitations, and their potential applications for diabetic foot assessment are detailed in this article. The introduction of advanced MR imaging multiparametric protocols, with the aim of enhancing the overall diagnostic accuracy of MR imaging, may help in treatment decision making and lead to improved patient outcomes. RSNA, 2017.

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Section: Mr Angiographymentioning

confidence: 99%

Advanced MR Imaging Techniques for Differentiation of Neuropathic Arthropathy and Osteomyelitis in the Diabetic Foot

et al. 2017

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“…Despite its high sensitivity, MRI application for the recognition of osteomyelitis in the diabetic foot is compromised due to lower specificity related to Charcot neuropathic osteoarthropathy. In addition, if there is inflammatory hyperemia, the diagnostic accuracy is further hampered to 40-50% [40]. In a recent study by Bae et al [41] in 35 cases, three-phase bone scans showed a sensitivity of 83% (5/6), specificity of 93% (27/29), positive predictive value (PPV) of 71% (5/7), and negative predictive value (NPV) of 96% (18/27) in the diagnosis of osteomyelitis.…”

Section: Resultsmentioning

confidence: 99%

Diagnostic value of 99mTc-ubiquicidin scintigraphy for osteomyelitis and comparisons with 99mTc-methylene diphosphonate scintigraphy and magnetic resonance imaging

Assadi

Vahdat²,

Nabipour³

et al. 2011

Nuclear Medicine Communications

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Objective The discrimination of bacterial infections from sterile inflammatory processes is of great importance in the management of inflammation. Currently available techniques cannot decisively address this issue. In this respect, antimicrobial peptide 99m Tc-ubiquicidin (UBI) 29-41 scans have been showing interesting results. The aim of this study was to determine the accuracy of 99m Tc-UBI scan in the detection of osteomyelitis and to compare it with 99m Tc-methylene diphosphonate scan and magnetic resonance imaging (MRI).Methods Twenty patients (mean age = 48.90 years) with suspected osteomyelitis were included in this study. After evaluation of each patient through history taking, physical examination, appropriate laboratory tests, and other processes including bone probing, wound culture, and plain film radiography, MRIs, 99m Tc-UBI scans, and 99m Tc-methylene diphosphonate scans were performed. For quantitative analysis, the mean count of abnormal-tonormal (A/N) region was calculated for images acquired at 15, 30, 45, 60, 120, and 240 min to obtain the most favorable time for imaging. Results In total, osteomyelitis was detected in the 99mTc-UBI scans of 17 patients, indicating 100% accuracy, compared with an accuracy of 90% for osteomyelitis detected in three-phase bone scans. The maximum mean A/N was observed at 15 min after intravenous injection (median: 1.91; interquartile range: 1.54-2.94). MRI was performed in 12 cases only with 75% accuracy. In addition, the A/N ratios for the 99m Tc-UBI scans were not significantly different between patients with or without Staphylococcus aureus growth on wound cultures.Conclusion For fast imaging with high accuracy, 99m Tc-UBI 29-41 is a suitable choice for the detection of osteomyelitis.

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“…• Lavery et al 33 • Ertugrul et al 34 • Fleischer et al 35 • Meyr et al 36 • Rozzanigo et al 37 Guideline #3.7…”

Section: Evidencementioning

confidence: 99%

What's new in the literature: An update of new research since the original WHS diabetic foot ulcer guidelines in 2006

Braun

Kim

Margolis

et al. 2014

Wound Repair Regeneration

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Role of magnetic resonance imaging in the evaluation of diabetic foot with suspected osteomyelitis

Cited by 37 publications

References 20 publications

Advanced MR Imaging Techniques for Differentiation of Neuropathic Arthropathy and Osteomyelitis in the Diabetic Foot

Advanced MR Imaging Techniques for Differentiation of Neuropathic Arthropathy and Osteomyelitis in the Diabetic Foot

Diagnostic value of 99mTc-ubiquicidin scintigraphy for osteomyelitis and comparisons with 99mTc-methylene diphosphonate scintigraphy and magnetic resonance imaging

What's new in the literature: An update of new research since the original WHS diabetic foot ulcer guidelines in 2006

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