Skeletal Radiology

, Volume 48, Issue 3, pp 405–411 | Cite as

Added value of MRI to X-ray in guiding the extent of surgical resection in diabetic forefoot osteomyelitis: a review of pathologically proven, surgically treated cases

  • Micah CohenEmail author
  • Brett Cerniglia
  • Tetyana Gorbachova
  • Jay Horrow
Scientific Article



This study retrospectively evaluated the added value of MRI over X-ray in guiding the extent of amputation in a cohort of patients with surgically treated, pathologically proven osteomyelitis.

Materials and methods

A database search revealed 32 cases of pathology-proven diabetic forefoot osteomyelitis between 2006 and 2016, in which X-ray, MRI, and surgery occurred within 30 days. Data collection included extent of osteomyelitis reported on imaging and extent of subsequent amputation using a point system. Added value of MRI over X-ray in guiding surgical resection was stated if the X-ray was negative, MRI was positive, and there was MRI–surgical concordance; if both modalities were positive, X-ray was discordant whereas the MRI was concordant; or if MRI detected an abscess. Two-tailed Fisher’s exact test compared proportions.


In 9 cases that were positive on both modalities, MRI identified an average of 1.2 additional bone segments of disease. There was surgical agreement with X-ray in 3 out of 31 cases (9.7%, 95%CI 0–20.1) and with MRI in 17 out of 31 cases (55%, 37.3–72.4; p < 0.0001). There was an added value of MRI over X-ray in guiding surgical treatment in 64.5% of cases (95% CI 47.7%–81.4%). MRI added value in 5 out of 9 X-rays positive for osteomyelitis and in 15 out of 22 negative (p value was not significant).


Magnetic resonance imaging demonstrated added value over X-ray in guiding surgical management in both X-ray-negative and -positive cases. Although multiple factors are involved in determining the degree of surgical excision, MRI is a clinically useful component of the diagnostic algorithm in patients who undergo surgical treatment.


MRI Diabetic infection Pedal osteomyelitis Forefoot 


Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflicts of interest.


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Copyright information

© ISS 2018

Authors and Affiliations

  • Micah Cohen
    • 1
    Email author
  • Brett Cerniglia
    • 1
  • Tetyana Gorbachova
    • 1
  • Jay Horrow
    • 2
  1. 1.Albert Einstein Medical CenterPhiladelphiaUSA
  2. 2.Drexel College School of MedicinePhiladelphiaUSA

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