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

Ruolo della risonanza magnetica nello studio del piede diabetico con sospetta osteomielite

  • Musculoskeletal Radiology/Radiologia Muscolo-Scheletrica
  • Published:
La radiologia medica Aims and scope Submit manuscript

Abstract

Purpose

This study evaluated Magnetic Resonance Imaging (MRI) in infected diabetic foot ulcers.

Materials and methods

Sixteen diabetic patients underwent foot MRI between January 2006 and September 2007 for suspected unilateral osteomyelitis. Three of 16 patients showed radiographic changes due to Charcot neuropathic osteoarthropathy. Twelve of 16 patients also underwent MR angiography of the lower limbs for the purpose of planning surgical or endovascular treatment. The musculoskeletal and vascular MRI studies were retrospectively reviewed by three radiologists.

Results

The final diagnosis, based on clinical, imaging, microbiological and histological findings, was osteomyelitis in 13/16 cases. Foot MRI allowed a correct diagnosis in 15/16 patients, with 1 false positive result demonstrated by computed tomography (CT)-guided bone biopsy. MR angiography of the lower limbs was considered nondiagnostic in 5/12 patients in the infrapopliteal region owing to venous contamination.

Conclusions

MRI has high sensitivity for the detection of osteomyelitis in the diabetic foot but lower specificity related to Charcot neuropathic osteoarthropathy. If diagnostic uncertainty persists, a bone biopsy is indicated. The inflammatory hyperaemia caused by the ulcer deteriorates the diagnostic quality of 40%–50% of MR angiography studies in the infrapopliteal region. In these cases, selective arteriography is appropriate, as it can be performed in the same session as angioplasty.

Riassunto

Obiettivo

Valutare l’approccio con Risonanza Magnetica (RM) al piede diabetico con ulcera infetta.

Materiali e metodi

Sedici pazienti diabetici sono stati sottoposti da gennaio 2006 a settembre 2007 a RM del piede per sospetta osteomielite monolaterale; in 3/16 vi erano alterazioni radiografiche da osteo-artropatia neuropatica di Charcot. Dodici/16 pazienti hanno eseguito anche l’angio-RM degli arti inferiori per pianificare il trattamento chirurgico o endovascolare. Gli esami RM muscolo-scheletrici e vascolari sono stati valutati retrospettivamente da tre radiologi.

Risultati

La diagnosi finale, basata sui rilievi clinici, imaging, microbiologici e istologici è stata di osteomielite in 13/16 casi. La RM del piede ha consentito la diagnosi corretta in 15/16 pazienti, con 1 falso positivo, dimostrato dalla biopsia ossea TC-guidata. L’angio-RM degli arti inferiori è stata considerata non diagnostica nel distretto infra-popliteo in 5/12 pazienti a causa di artefatti da contaminazione venosa.

Conclusioni

La RM ha elevata sensibilità per l’osteomielite nel piede diabetico, ma più bassa specificità dovuta soprattutto all’osteo-artropatia neuropatica di Charcot; se permane dubbio diagnostico è indicata la biopsia ossea. L’iperemia flogistica causata dall’ulcera deteriora il 40%–50% degli studi angio-RM a livello sottopopliteo: in tali casi è appropriata l’arteriografia selettiva per la possibilità di effettuare angioplastica nella stessa seduta.

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Authors and Affiliations

  1. Diagnostic Imaging Unit, Carlo Poma Hospital, Viale Albertoni 1, 46100, Mantua, Italy

    U. Rozzanigo, A. Tagliani, E. Vittorini & R. Caudana

  2. Vascular Surgery Unit, Carlo Poma Hospital, Viale Albertoni 1, 46100, Mantua, Italy

    R. Pacchioni

  3. Orthopaedics and Traumatology Unit, Carlo Poma Hospital, Viale Albertoni 1, 46100, Mantua, Italy

    L. Renzi Brivio

Authors
  1. U. Rozzanigo
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  2. A. Tagliani
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  3. E. Vittorini
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  4. R. Pacchioni
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  5. L. Renzi Brivio
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  6. R. Caudana
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Corresponding author

Correspondence to R. Caudana.

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Rozzanigo, U., Tagliani, A., Vittorini, E. et al. Role of magnetic resonance imaging in the evaluation of diabetic foot with suspected osteomyelitis. Radiol med 114, 121–132 (2009). https://doi.org/10.1007/s11547-008-0337-7

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  • DOI: https://doi.org/10.1007/s11547-008-0337-7

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