MRI useful for identifying bone lesions in diabetic feet

By Ingrid Grasmo

Identification of specific bone lesions in the feet of patients with diabetes can be achieved with magnetic resonance imaging (MRI), show study findings.

Feet are commonly affected in patients with diabetes, so early diagnosis is essential in order to implement prompt and appropriate medical care and to avoid amputation.

"The diabetic foot can be considered as [a] distinct entity, per se, because of the variety of derangements detected clinically," say Inger Roug (Roug Radiology, Woodstock, Georgia, USA) and Claude Pierre-Jerome (Emory University, Atlanta, Georgia).

In this retrospective study, the researchers assessed radiographic and MRI foot examinations from 85 diabetic patients (90 feet) to assess the prevalence of bone marrow changes. These included vascular (infarct and necrosis) and traumatic (bruise and occult fractures) changes, destruction and debris, dislocation, osteochondritis, and osteomyelitis.

In total, 17 (18.9%) feet presented with vascular changes, of which 11 (65%) presented with infarct and six (35%) with necrosis. The team also found that 20 (22.2%) feet had traumatic changes and that half of these had edema that was visible on MRI.

Occult fractures with a visible fracture line on MRI were observed in five (25%) patients and another five patients presented with visible fractures on both X-ray and MRI.

Other traumatic changes that were identified among patients included bone destruction (eight feet, 8.9%), with bony debris visualized on X-rays in three of them. Furthermore, bone dislocation and displacement occurred in 11 (12.2%) patients, with the navicular bone most frequently dislocated.

Osteochondral lesions were observed in 24 (26.7%) feet, and occurred most often in the talus. The researchers also found evidence of osteomyelitis in 10 (11.1%) feet, all of which were diagnosed as an acute condition with associated adjacent soft tissue infection. Bones most frequently affected were the phalanges, the calcaneus, and the cuboid.

"The use of intravenous contrast with MRI may help in the diagnosis of osteomyelitis as well as in other entities, such as infarct and necrosis," say the researchers in the European Journal of Radiology.

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