high morbidity lifetime ulcer risk for diabetics 25%
TRANSCRIPT
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Diabetes-Related Foot Pathology
High morbidity Lifetime ulcer risk for diabetics 25% Nearly all diabetes-related foot infection
secondary from ulcer
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Nothing To Disclosure
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MRI Sensitivity & Specificity Osteomyelitis of Diabetic Feet
1995 (no Gd): 82% sensitivity, 80% specificity 1997 (with Gd): 90% sensitivity, 70% specificity
no effect of Gd (disputes earlier data)
2007 (no Gd): 90% senisitivity, 83% specificity
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MRI Primary Findings
Marrow signal (HIGH STIR/T2 & LOW T1)* Gd Marrow enhancement
Ulcer or sinus tract leading to bone with abnormal
marrow signal Presence of abscess
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MRI Secondary Signs
Cellulitis Foreign body Periosteal reacton
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Osteomyelitis vs. Neuropathic Charcot
Marrow signal change
Single bone Diffuse infiltration Minimal deformity Ulcer, sinus tract, abscess Wgt. bearing: fore/hind
foot
Marrow signal change Multiple bones Periarticular &
subchondral Deformity with bone
debris Edema but intact skin Non-wgt. bearing:
midfoot
Osteomyelitis Neuropathic Charcot
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Location, Location, Location
Neuroarthopathy (Charcot)--MIDFOOT: Tarsal-Tarsal Tarsometatarsal (TMT)
Osteomyelitis FORE & HINDFOOT: Distal to tarsometatarsal Calcaneus Malleoli
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Distal phalangeal osteomyelitis
Low T1 signal
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Distal phalangeal osteomyelitis
High T2 signal
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Distal phalangeal osteomyelitis
Gd enhancement
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Metatarsal head osteomyelitis with sinus tract
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Forefoot osteomyelitis with contiguous abscess
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Abscess and Osteomyelitis
20% of osteomyelitis are + for soft tissue abscess 100% correlation with osteomyelitis (same as sinus
tract) Abscess more common in post surgical foot 50% of all abscesses in fore foot and are directly
contiguous Mid/Hind foot abscess may be remote from site of
osteomyelitis
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Calcaneus osteomyelitis with sinus tract and abscess
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Osteomyelitis with intramedullary bone abscess of talus
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Osteomyelitis: confluent, geographic medullary distribution
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No osteomyelitis: Ulcer with minimal subcortical T1/T2 signal
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Osteomyelitis: ulcer with confluent abnomal T1 signal
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No osteomyelitis: T1 “hazy” pattern
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No osteomyelitis: T1 reticulated pattern
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Neuropathic arthropathy of midfoot
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Neuropathic arthropathy of midfoot
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Neuropathic arthropathy with superimposed osteomyelitis
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Bone Biopsy
For histological proven osteomyelitis, positive rate of percutaneous biopsy: 50% 42% 34% (largest study)
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Bone Biopsy
Aspiration of > 2cc’s purulent fluid—83% positive osteomyelitis rate.
Risk of seeding uninfected tissue. Utility of identifying an organism?