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Estudio primario

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The diagnosis of osteomyelitis of the foot in diabetes: microbiological examination vs. magnetic resonance imaging and labelled leucocyte scanning.

Revista Diabetic medicine : a journal of the British Diabetic Association
Año 2006
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AIMS: Foot infections and their sequelae are among the most common and severe complications of diabetes mellitus. As diabetic patients with foot infections develop osteomyelitis and may progress to amputation, early diagnosis of osteomyelitis is critical. METHODS: We compared the diagnostic values of labelled leucocyte scanning with Tc(99)m, magnetic resonance imaging (MRI) and microbiological examination of bone tissue specimens with histopathology, the definitive diagnostic procedure. Thirty-one diabetic patients with foot lesions were enrolled in the study and histopathological examination was performed in all. Patients had clinically suspected foot lesions of > or = grade 3 according to the classification of Wagner. RESULTS: Bone specimens were obtained for histopathological examination. Microbiology had a sensitivity of 92% and specificity of 60%. Labelled leucocyte scanning had a sensitivity of 91%, specificity of 67%, and MRI a sensitivity of 78%, specificity of 60%. CONCLUSIONS: Microbiological examination may be as useful as and less costly than other diagnostic procedures and is the only method which can guide the choice of antibiotic therapy.

Estudio primario

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MR imaging of neuropathic feet in leprosy patients with suspected osteomyelitis.

Revista International journal of leprosy and other mycobacterial diseases : official organ of the International Leprosy Association
Año 2002
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This study was undertaken to analyze MRI findings in leprosy patients with neuropathic feet, which are suspected of having osteomyelitis. As far as we know, there is no literature concerning osteomyelitis and MRI in neuropathic leprosy feet at present. Therefore, we have included MRI examination of 18 events of suspected osteomyelitis in 12 leprosy patients. All patients with long-standing neuropathic foot problems were clinically suspected of having osteomyelitis. All patients underwent the MRI protocol with the inclusion of Two Point Dixon Chemical Shift Imaging as a fat-suppression sequence. For the MRI evaluation, we used signs that are described in literature for detecting osteomyelitis in diabetic feet. The primary MRI signs were positive in 17 of 18 patients. The secondary MRI signs were positive in 100% of the patients. Our results show that MRI with the use of Two Point Dixon Chemical Shift Imaging is a promising diagnostic modality to detect osteomyelitis in the presence of neurosteoarthropathic changes in patients with leprosy. Whenever available, MRI could play an important role in detecting osteomyelitis in leprosy patients with long-standing neuropathic feet.

Estudio primario

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Nonenhancing tissue on MR imaging of pedal infection: characterization of necrotic tissue and associated limitations for diagnosis of osteomyelitis and abscess.

Revista AJR. American journal of roentgenology
Año 2002
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OBJECTIVE: We studied the frequency, location, extent, and signal characteristics of nonenhancing tissue in pedal infections and correlated those areas with surgical and histologic findings. MATERIALS AND METHODS: One hundred ten contrast-enhanced 1.5-T MR imaging foot examinations in 102 patients (28 women, 74 men; mean age, 59 years), 82% of whom had diabetes mellitus, were reviewed by two musculoskeletal radiologists for the presence of areas without recognizable enhancement. The number, size, location, signal characteristics, and enhancement ratio of nonenhancing regions were noted. MR imaging findings were compared with surgical and histology reports. RESULTS: Nonenhancing regions were found in 27 feet (24.5%, 96.3% in diabetic patients, p = 0.032) at the forefoot (n = 16), toes (n = 8), and heel (n = 3). The mean size of the nonenhancing regions was 4.1 x 2.7 x 1.4 cm. Signal characteristics on T1-weighted images were isointense to muscle (n = 21, 77.8%), hypointense to muscle (n = 3, 11.1%), heterogeneous (n = 2, 7.4%), and isointense to fat (n = 1, 3.7%). On T2-weighted images, the signal was hyperintense to muscle (n = 12, 44.4%), heterogeneous to muscle (n = 9, 33.3%), equal to fluid (n = 3, 11.1%), and hypointense to muscle (n = 3, 11.1%). The mean signal increase after contrast administration was 3.57% for observer 1 and 2.68% for observer 2. Necrotic tissue was surgically confirmed in the nonenhancing areas in 26 feet (96.3%). Five abscesses and three cases of osteomyelitis were misdiagnosed on MR images because of lack of enhancement. CONCLUSION: Nonenhancing areas are seen in one fourth of pedal infections, occur almost exclusively in diabetic patients, and represent necrotic tissue. Only contrast-enhanced images allow reliable recognition of these regions. Lack of enhancement in these areas can mask the presence of abscess and osteomyelitis.

Estudio primario

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Correlation of imaging techniques to histopathology in patients with diabetic foot syndrome and clinical suspicion of chronic osteomyelitis. The role of high-resolution ultrasound.

Revista Diabetes care
Año 1999
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OBJECTIVE: To investigate the role of ultrasound in the diagnosis of osteomyelitis in the diabetic foot compared with magnetic resonance imaging (MRI), bone scintigraphy (BS), and plain film radiography (PFR). RESEARCH DESIGN AND METHODS: We investigated 19 consecutive diabetic patients (2 women, 17 men, age 60.7 +/- 9.8 years, BMI 27.0 +/- 3.8 kg/m2) with clinical suspicion of bone infection of the foot. A high-resolution ultrasound system (Esaote/Biosound, Munich) with a linear array transducer up to 13.0 MHz was used. The prospective and blinded results of each method were compared with histopathology as the reference method after metatarsal resection. RESULTS: In 14 of 19 patients, histopathology confirmed osteomyelitis. Ultrasound showed a sensitivity of 79% (PFR, 69%; BS, 83%; MRI, 100%), a specificity of 80% (PFR, 80%; BS, 75%; MRI, 75%), a positive predictive value of 92% (PFR, 90%; BS, 91%; MRI, 93%), and a negative predictive value of 57% (PFR, 50%; BS, 60%; MRI, 100%). CONCLUSIONS: Our data indicate that ultrasound might have a better diagnostic power for detecting chronic osteomyelitis in the diabetic foot than PFR and has similar sensitivity and specificity as BS. MRI is superior to the other three methods. We conclude that the use of ultrasound in the management of the diabetic foot is worthy of further investigation.

Estudio primario

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The detection of pedal osteomyelitis in diabetic patients

Revista Practical Diabetes International
Año 1999
Enlaces DOI https://doi.org/10.1002/pdi.1960160404

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Abstract Pedal osteomyelitis in diabetic patients is a serious clinical problem. There is no single, reliable diagnostic tool; plain films are inaccurate, bone scans nonspecific and the role of human pooled immunoglobulin (Hig) scans remains unclear. Magnetic Resonance Imaging (MRI) may prove useful. We therefore aimed to compare these four diagnostic modalities. Thirteen diabetic patients with possible pedal osteomyelitis were recruited. Nine were found to have osteomyelitis based on clinical, microbiological, and surgical findings. All were scanned with all four modalities and the results compared. MRI scans correctly identified all positive cases, with two false positive cases, and excelled in localising infection, allowing for surgical planning. Plain film and Hig scans were less sensitive (6/9 and 7/9 cases, respectively), were difficult to interpret and were poor in localising infection. Bone scans identified eight of the nine cases, with no false positives. In conclusion, this small study suggests that plain films and Hig scans did not confer any additional benefit in the diagnosis of pedal osteomyelitis. Bone scans are a useful screening tool, but when positive an MRI scan should be sought to confirm the diagnosis.

Estudio primario

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The value of combined radionuclide and magnetic resonance imaging in the diagnosis and conservative management of minimal or localized osteomyelitis of the foot in diabetic patients.

Revista Metabolism: clinical and experimental
Año 1999
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Early diagnosis of osteomyelitis is helpful for a successful conservative treatment. The value of bone scanning combined with granulocytes labeled with hexamethylpropylene amine oxime (HMPAO) granulocyte-Tc99m (GN) radionuclide imaging (combined [RI]) with magnetic resonance imaging (MRI) for the diagnosis of osteomyelitis was assessed in 24 diabetic patients with foot ulcers. Evidence of osteomyelitis was based on the presence of at least one of the following criteria: (1) clinical bone involvement, (2) radiological bone involvement, (3) both positive combined RI and MRI, and (4) evidence of clinical bone involvement during the follow-up period. Thirteen patients had osteomyelitis. Seven patients had clinical bone involvement (sensitivity, 54%), five had radiological bone involvement (sensitivity, 38%), and 10 had positive combined RI for osteomyelitis (sensitivity, 77%). MRI demonstrated a higher sensitivity (100%). The specificity for combined RI and MRI was 82%. These results lead to a new diagnostic strategy for the early detection of minimal or localized osteomyelitis to avoid amputations. MRI is most appropriate following a negative x-ray in determining whether to treat osteomyelitis, since a negative MRI result rules out osteomyelitis. Antibiotic therapy should be used in the case of a positive MRI result, but Charcot joint disease can lead to false-positive MRI results. In this case, combined RI should be performed.

Estudio primario

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Detection of osteomyelitis in the neuropathic foot: nuclear medicine, MRI and conventional radiography.

Revista Clinical nuclear medicine
Año 1998
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The diagnostic efficacy of (1) combined three-phase bone scintigraphy and In-111 labeled WBC scintigraphy (Bone/WBC), (2) MRI, and (3) conventional radiography in detecting osteomyelitis of the neuropathic foot was compared. Conventional radiography was comparable to MRI for detection of osteomyelitis. MRI best depicted the presence of osteomyelitis in the forefoot. Particularly in the setting of Charcot joints, Bone/WBC was more specific than conventional radiography or MRI.

Estudio primario

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Osteomyelitis of the foot: relative importance of primary and secondary MR imaging signs.

Revista Radiology
Año 1998
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PURPOSE: To determine the usefulness of primary and secondary magnetic resonance (MR) imaging signs of osteomyelitis. MATERIALS AND METHODS: MR imaging at 1.5 T was performed in 73 feet (62 patients) with clinical concern for osteomyelitis. Images were reviewed retrospectively and separately by two reviewers in a blinded fashion for primary (abnormal marrow signal intensity) and secondary (ulcer, cellulitis, soft-tissue mass, abscess, sinus tract, cortical interruption) signs associated with osteomyelitis. RESULTS: Of the 73 feet, 43 had osteomyelitis. Discordant marrow signal intensity between individual MR sequences was observed by reader 1 in six (8%) feet and by reader 2 in 15 (21%) feet. For primary signs, fast spin-echo short inversion time inversion-recovery and gadolinium-enhanced fat-suppressed T1-weighted images had the highest sensitivity, and T1-weighted and gadolinium-enhanced fat-suppressed T1-weighted images had the highest specificity and least interobserver variability. Signs of cutaneous ulcer, sinus tract, and cortical interruption had the highest positive predictive value for osteomyelitis; signs of soft-tissue mass and cortical interruption had the highest negative predictive value. All had good interobserver agreement except cellulitis. CONCLUSION: When osteomyelitis of the foot is suspected, marrow signal intensity can differ on different types of MR images. Identification of secondary signs may augment diagnostic confidence when abnormal marrow signal intensity is seen.

Estudio primario

No clasificado

99mTc-nanocolloid scintigraphy for assessing osteomyelitis in diabetic neuropathic feet.

Revista Clinical radiology
Año 1998
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Distinguishing osteomyelitis from neuropathic osteoarthropathy in diabetic feet is a common and difficult clinical problem with no highly accurate discriminatory investigation. This study assesses the novel use of marrow scintigraphy and compares it with magnetic resonance imaging (MRI) for the diagnosis of osteomyelitis in neuropathic osteoarthropathic diabetic feet. Nine diabetic patients with chronic foot ulcers were prospectively assessed independently using 99mTc-nanocolloid scintigraphy and MRI. Those patients showing features of osteomyelitis underwent percutaneous bone biopsy or surgical ray excision for histological confirmation. Other patients were followed up clinically for a minimum of 6 months to exclude osteomyelitis. Marrow scintigraphy, in agreement with MRI, demonstrated all four cases of biopsy proven osteomyelitis and excluded three cases with neuropathic osteoarthropathy alone. One case of suspected osteomyelitis of the ankle on marrow scintigraphy, but not MRI, was not confirmed clinically. One case of suspected osteomyelitis on both imaging modalities was shown on biopsy to demonstrate changes of avascular necrosis but not osteomyelitis. In this study 99mTc-nanocolloid scintigraphy shows a sensitivity of 100% and specificity of 60%. An important false positive result is seen with avascular necrosis, both on marrow scintigraphy and on MRI. Although larger studies are needed to evaluate this technique, 99mTc-nanocolloid marrow scintigraphy may be an alternative to MRI for assessing diabetic feet for osteomyelitis.

Estudio primario

No clasificado

Osteomyelitis of the diabetic foot: MR imaging-pathologic correlation.

Revista Radiology
Año 1997
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PURPOSE: To evaluate the efficacy of magnetic resonance (MR) imaging for the diagnosis of osteomyelitis in the diabetic foot by using anatomic and histologic studies of the resected tissue as a standard of reference. MATERIALS AND METHODS: Thirteen diabetic patients with high clinical suspicion of osteomyelitis underwent a total of 15 MR examinations before surgery. Correlation was made between MR findings and the histologic features of the resected tissue, which included 57 bones. RESULTS: Maximum signal intensity on the T2-weighted or short inversion time inversion-recovery images of the bones was due to osteomyelitis (prospective sensitivity, 90%; specificity, 71%). Eighteen bones with increased signal intensity showed only edema of the marrow. The range of signal intensity in edema overlapped that in osteomyelitis but was lower. The use of gadopentetate dimeglumine improved delineation of soft-tissue inflammatory masses, but this contrast material was not useful in distinguishing osteomyelitis from edema. CONCLUSION: Marrow edema cannot be reliably distinguished from osteomyelitis with MR imaging. Gadopentetate dimeglumine is of limited use. Some previously published false-positive reports of osteomyelitis were most likely due to edema of the marrow. MR imaging is useful in planning surgery of the infected diabetic foot, as it enables reliable distinction between normal and abnormal areas.