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Efficacy of Magnetic Resonance Imaging in Diagnosing Diabetic Foot Osteomyelitis in the Presence of Ischemia

      Abstract

      Magnetic resonance imaging (MRI) has been recognized as the most accurate imaging modality for the detection of diabetic foot osteomyelitis. However, how accurately MRI displays the extent of diabetic foot osteomyelitis in the presence of ischemia is still unclear. We retrospectively compared the preoperative MRI findings with the results of histopathologic examinations of resected bones and studied the efficacy of MRI in the diagnosis of diabetic foot osteomyelitis of different etiologies. A total 104 bones from 18 foot ulcers in 16 diabetic patients (10 men and 6 women; age range 42 to 84 years) treated by surgical intervention from 2008 to 2012 was examined. In 8 neuropathic ulcers, 29 bones were accurately diagnosed in detail using MRI, even those with severe soft tissue infection. Of 75 bones in 10 ischemic ulcers, only 7 bones evaluated by MRI after revascularization were diagnosed accurately; the other 68 could not be diagnosed because of unclear or equivocal MRI findings. On histopathologic examination, all the bones were found to be infected through the bone cortex by the surrounding infected soft tissue, not directly by articulation. Overall, preoperative MRI is effective in the diagnosis of neuropathic ulcers, but less so of ischemic ones.

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      References

        • Lipsky B.A.
        • Berendt A.R.
        • Deery H.G.
        • Embil J.M.
        • Joseph W.S.
        • Karchmer A.W.
        • LeFrock J.L.
        • Lew D.P.
        • Mader J.T.
        • Norden C.
        • Tan J.S.
        • Infectious Diseases Society of America
        Diagnosis and treatment of diabetic foot infections.
        Plast Reconstr Surg. 2006; 117: 212S-238S
        • Lipsky B.A.
        • Berendt A.R.
        • Cornia P.B.
        • Pile J.C.
        • Peters E.J.
        • Armstrong D.G.
        • Deery H.G.
        • Embil J.M.
        • Joseph W.S.
        • Karchmer A.W.
        • Pinzur M.S.
        • Senneville E.
        • Infectious Diseases Society of America
        2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections.
        Clin Infect Dis. 2012; 54: e132-e173
        • Lipsky B.A.
        • Peters E.J.G.
        • Senneville E.
        • Berendt A.R.
        • Embil J.M.
        • Lavery L.A.
        • Urbančič-Rovan V.
        • Jeffcoate W.J.
        Expert opinion on the management of infections in the diabetic foot.
        Diabetes Metab Res Rev. 2012; 28: 163-178
        • Aragón-Sánchez J.
        Treatment of diabetic foot osteomyelitis: a surgical critique.
        Int J Low Extrem Wounds. 2010; 9: 37-59
        • Ha Van G.
        • Siney H.
        • Danan J.P.
        • Sachon C.
        • Grimaldi A.
        Treatment of osteomyelitis in the diabetic foot: contribution of conservative surgery.
        Diabetes Care. 1996; 19: 1257-1260
      1. Fujii M, Terashi H. Efficacy of magnetic resonance imaging in diagnosing diabetic foot osteomyelitis. J Am Podiatr Med Assoc (in press).

        • Terashi H.
        • Kitano I.
        • Tsuji Y.
        Total management of diabetic foot ulcerations—Kobe classification as a new classification of diabetic foot wounds.
        Keio J Med. 2011; 60: 17-21
        • Smith A.J.
        • Daniels T.
        • Bohnen J.M.
        Soft tissue infections and the diabetic foot.
        Am J Surg. 1996; 172: 7S-12S
        • Schultz G.S.
        • Sibbald R.G.
        • Falanga V.
        • Ayello E.A.
        • Dowsett C.
        • Harding K.
        • Romanelli M.
        • Stacey M.C.
        • Teot L.
        • Vanscheidt W.
        Wound bed preparation: a systematic approach to wound management.
        Wound Repair Regen. 2003; 11: S1-28
        • Meade J.W.
        • Mueller C.B.
        Major infections of the foot.
        Med Times. 1968; 96: 154-165
        • O'Neal L.W.
        Surgical pathology of the foot and clinicopathologic correlations.
        in: Levin M.E. O'Neal L.W. The Diabetic Foot. Mosby, St. Louis1983: 483-512
        • Rayman G.
        • Vas P.R.
        • Baker N.
        • Taylor Jr., C.G.
        • Gooday C.
        • Alder A.I.
        • Donohoe M.
        The Ipswich touch test: a simple and novel method to identify inpatients with diabetes at risk of foot ulceration.
        Diabetes Care. 2011; 34: 1517-1518
        • Morrison W.B.
        • Schweitzer M.E.
        • Batte W.G.
        • Radack D.P.
        • Russel K.M.
        Osteomyelitis of the foot: relative importance of primary and secondary MR imaging signs.
        Radiology. 1998; 207: 625-632
        • Shank C.F.
        • Feibel J.B.
        Osteomyelitis in the diabetic foot: diagnosis and management.
        Foot Ankle Clin. 2006; 11: 775-789
        • Donovan A.
        • Schweitzer M.E.
        Current concepts in imaging diabetic pedal osteomyelitis.
        Radiol Clin North Am. 2008; 46: 1105-1124
        • Rozzanigo U.
        • Tagliani A.
        • Vittorini E.
        • Pacchioni R.
        • Brivio L.R.
        • Caudana R.
        Role of magnetic resonance imaging in the evaluation of diabetic foot with suspected osteomyelitis.
        Radiol Med. 2008; 114: 121-132
        • Gnanasegaran G.
        • Chicklore S.
        • Vijayanathan S.
        • O'Doherty M.J.
        • Fogelman I.
        Diabetes and bone: advantages and limitations of radiological, radionuclide and hybrid techniques in the assessment of diabetic foot.
        Minerva Endocrinol. 2009; 34: 237-254
        • Collins M.S.
        • Schaar M.M.
        • Wenger D.E.
        • Mandrekar J.N.
        T1-weighted MRI characteristics of pedal osteomyelitis.
        AJR Am J Roentgenol. 2005; 185: 386-393
        • Russell J.M.
        • Peterson J.J.
        • Bancroft L.W.
        MR imaging of the diabetic foot.
        Magn Reson Imaging Clin North Am. 2008; 16: 59-70
        • Ahmadi M.E.
        • Morrison W.B.
        • Carrino J.A.
        • Schweitzer M.E.
        • Raikin S.M.
        • Ledermann H.P.
        Neuropathic arthropathy of the foot with and without superimposed osteomyelitis: MR imaging characteristics.
        Radiology. 2006; 238: 622-631
        • Thorning C.
        • Gedroyc W.M.
        • Tyler P.A.
        • Dick E.A.
        • Hui E.
        • Valabhji J.
        Midfoot and hindfoot bone marrow edema identified by magnetic resonance imaging in feet of subjects with diabetes and neuropathic ulceration is common but of unknown clinical significance.
        Diabetes Care. 2010; 33: 1602-1603
        • Ciampolini J.
        • Harding K.G.
        Pathophysiology of chronic bacterial osteomyelitis: why do antibiotics fail so often?.
        Postgrad Med J. 2000; 76: 479-483
        • Armstrong D.G.
        • Lavery L.A.
        • Harkless L.B.
        Validation of a diabetic wound classification system: the contribution of depth, infection, and ischemia to risk of amputation.
        Diabetes Care. 1998; 21: 855-859
        • Wagner F.W.
        The dysvascular foot: a system for diagnosis and treatment.
        Foot Ankle. 1981; 2: 64-122
        • Chan J.C.
        • Malik V.
        • Jia W.
        • Kadowaki T.
        • Yajnik C.S.
        • Yoon K.H.
        • Hu F.B.
        Diabetes in Asia: epidemiology, risk factors, and pathophysiology.
        JAMA. 2009; 301: 2129-2140

      Linked Article

      • Erratum
        The Journal of Foot and Ankle SurgeryVol. 54Issue 3
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          In the article, “Efficacy of Magnetic Resonance Imaging in Diagnosing Diabetic Foot Osteomyelitis in the Presence of Ischemia” (2013;52[6]:717-723), the name of one of the authors was spelled incorrectly. It should be David G. Armstrong, DPM, MD, PhD, FACFAS.
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