Abstract
Fourteen diabetic patients with suspected foot infection and/or neuropathic joint (Charcot Joint) were evaluated with magnetic resonance imaging (MRI) in an attempt to assess the extent of the infection and also to distinguish infection from the changes seen with neuroarthropathy. The majority of patients with infection had more than one site of involvement and the following diagnoses were made by MRI evaluation: osteomyelitis (n = 8), abscess (n = 7), neuropathic joint (n = 5), septic arthritis (n = 4), and tenosynovitis (n = 4). Clinical or surgical/pathological confirmation of the MRI diagnoses was obtained in all but nine sites of infection or cases of neuropathic joint. If the two diagnostic categories of septic arthritis and tenosynovitis are excluded, all but four of the MRI diagnoses were confirmed. A distinctive pattern for neuroarthropathy was identified in five cases, consisting of low signal intensity on T1- and T2-weighted images within the bone marrow space adjacent to the involved joint. We conclude that MRI is a valuable adjunct in the evaluation of the diabetic foot, and that it provides accurate information regarding the presence and extent of infection in this subset of patients. MRI has proven particularly helpful in differentiating neuroarthropathy from osteomyelitis.
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Beltran J, McGhee RB, Shaffer PB, Olsen JO, Bennett WF, Foster TR, McCalla MS, Iskra LA, Blagg RL, Biller DS (1988) Experimental infections of the musculoskeletal system: Evaluation with MR imaging and Tc-99m MDP and Ga-67 scintigraphy. Radiology 167:167
Beltran J, Noto AM, McGhee RB, Freedy RM, McCalla MS (1987) Infections of the musculoskeletal system: High field-strength MR imaging. Radiology 164:449
Berquist TH, Brown ML, Fitzgerald RH, May GR (1985) Magnetic resonance imaging: Application in musculoskeletal infection. Magn Reson Imaging 3:219
Bessman AN, Wright W (1975) Nonclostridial gas gangrene. JAMA 233:958
Datz FL, Thome DA (1986) Effect of chronicity on the sensitivity of the In-111-labeled leukocyte scan. AJR 147:809
Duszynsky DO, Kuhn JP, Afshani E, Riddlesberger MM (1975) Early radionuclide diagnosis of acute osteomyelitis. Radiology 117:337
Edmons ME (1986) The diabetic foot: Pathophysiology and treatment. Clin Endocrinol Metab 15:889
Garnett ES, Cockshott WP, Jacobs J (1977) Classical acute osteomyelitis with negative bone scan. Br J Radiol 50:757
Gilday DL (1980) Problems in the scintigraphic detection of osteomyelitis. Radiology 135:791
Gilday DL, Eng B, Paul DJ, Paterson J (1975) Diagnosis of osteomyelitis in children by combined blood pool and bone imaging. Radiology 117:331
Handmaker H (1980) Acute hematogenous osteomyelitis: Has the bone scan betrayed us? Radiology 135:787
Handmaker H, Leonards R (1976) The bone scan in inflammatory osseous disease. Semin Nucl Med 6:95
Hernandez RJ (1985) Visualization of small sequestra by computerized tomography. Report of 6 cases. Pediatr Radiol 15:238
Kaufman J, Breeding L, Rosenberg N (1987) Anatomic location of acute diabetic foot infection. Its influence on the outcome of treatment. Am Surg 53:109
Kipper MS, Williams PJ (1983) Indium-111 white blood cell imaging. Clin Nucl Med 8:449
Kuhn JP, Berger PE (1979) Computed tomographic diagnosis of osteomyelitis. Radiology 130:503
Lisbona R, Rosenthal L (1977) Observations on the sequential use of 99m Tc-phosphate complex and 67-Ga imaging in osteomyelitis, cellulitis, and septic arthritis. Radiology 123:123
Maurer AH, Millmond SH, Knight LC, Mesgarzadeh M, Siegel JA, Shuman CR, Adler LP, Greene GS, Malmud LS (1986) Infection in diabetic osteoarthropathy: Use of indium-labeled leukocytes for diagnosis. Radiology 161:221
Quinn SF, Murray W, Clark RA, Cochran C (1988) MR imaging of chronic osteomyelitis. J Comput Assist Tomogr 12:113
Ram PC, Martinez S, Korobkin M, Breiman RS, Gallis HR, Harrelson JM (1981) CT detection of intraosseous gas: A new sign of osteomyelitis. AJR 137:721
Robson MC, Edstrom LE (1977) The diabetic foot: An alternative approach to major amputation. Surg Clin North Am 57:1089
Satoris DJ, Devine S, Resnick D, Golbranson F, Fierer J, Witztum K, Vasquez T, Kerr R, Pineda C (1985) Plantar compartmental infection in diabetic foot. The role of computed tomography. Invest Radiol 20:772
Sullivan DC, Rosenfield NS, Ogden J, Gotschalk A (1980) Problems in the scintigraphic detection of osteomyelitis in children. Radiology 135:731
Tany JSH, Gold RH, Bassett LW, Seeger LL (1988) Musculoskeletal infection of the extremities: Evaluation with MR imaging. Radiology 166:205
Taylor LM, Porter JM (1987) The clinical course of diabetics who require emergent foot surgery because of infection or ischemia. J Vase Surg 6:454
Teates CD, Williamson BRJ (1977) “Hot and cold” lesions in acute osteomyelitis. AJR 120:517
Wheat J (1985) Diagnostic strategies in osteomyelitis. Am J Med 78:218
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Beltran, J., Campanini, D.S., Knight, C. et al. The diabetic foot: magnetic resonance imaging evaluation. Skeletal Radiol. 19, 37–41 (1990). https://doi.org/10.1007/BF00197927
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DOI: https://doi.org/10.1007/BF00197927