Skip to main content

Advertisement

SpringerLink
Log in

Dynamic contrast-enhanced magnetic resonance imaging for differentiating osteomyelitis from acute neuropathic arthropathy in the complicated diabetic foot

  • Scientific Article
  • Published:
Skeletal Radiology Aims and scope Submit manuscript

Abstract

Objective

The main purpose of this study was to investigate the diagnostic value of dynamic contrast-enhanced MRI (DCE-MRI) in differentiating osteomyelitis from acute neuropathic arthropathy in the diabetic foot.

Materials and Methods

This prospective study was carried out on 30 diabetic foot patients, with a mean age of 51 years. The patients all underwent clinical examinations, laboratory examinations and DCE-MRI. The DCE-MRI parameters (Ktrans, Kep and Ve) of the regions of acute neuropathic arthropathy and osteomyelitis were calculated. Receiver operating characteristic curves (ROCs) were used to identify the DCE-MRI parameters that showed the highest accuracy in differentiating the acute neuropathic arthropathy from the osteomyelitic regions. Pearson correlation coefficients were used to assess the correlations among the DCE-MRI parameters, the level of C-reactive protein (CRP) and the erythrocyte sedimentation rate (ESR).

Results

The Ktrans, Kep and Ve values of the osteomyelitic regions were higher than those of the acute neuropathic arthropathy regions, and significant differences were found between the two groups (P = 0.000, P = 0.000, P = 0.000). The ROC analysis showed that Ktrans and Ve performed best in differentiating osteomyelitis from acute neuropathic arthropathy, both with an area under the curve of 0.938. The Pearson correlation coefficients showed that the DCE-MRI parameters correlated significantly with the level of CRP and ESR (P = 0.000, P = 0.014, P = 0.000; P = 0.000, P = 0.000, P = 0.013).

Conclusions

Our results showed that DCE-MRI may provide reproducible parameters that can reliably differentiate osteomyelitis from acute neuropathic arthropathy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Markanday A. Diagnosing diabetic foot osteomyelitis: narrative review and a suggested 2-step score-based diagnostic pathway for clinicians. Open Forum Infect Dis. 2014;1(2):ofu060.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Martin Noguerol T, Luna Alcala A, Beltran LS, Gomez Cabrera M, Broncano Cabrero J, Vilanova JC. Advanced MR imaging techniques for differentiation of neuropathic arthropathy and osteomyelitis in the diabetic foot. Radiographics. 2017;37(4):1161–80.

    Article  PubMed  Google Scholar 

  3. Aragon-Sanchez J, Lazaro-Martinez JL, Hernandez-Herrero C, Campillo-Vilorio N, Quintana-Marrero Y, Garcia-Morales E, et al. Does osteomyelitis in the feet of patients with diabetes really recur after surgical treatment? Natural history of a surgical series. Diabet Med. 2012;29(6):813–8.

    Article  PubMed  CAS  Google Scholar 

  4. Faglia E, Clerici G, Caminiti M, Curci V, Somalvico F. Influence of osteomyelitis location in the foot of diabetic patients with transtibial amputation. Foot Ankle Int. 2013;34(2):222–7.

    Article  PubMed  Google Scholar 

  5. Lipsky BA, Berendt AR, Cornia PB, Pile JC, Peters EJ, Armstrong DG, et al. 2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections. Clin Infect Dis. 2012;54(12):e132–73.

    Article  PubMed  Google Scholar 

  6. Game FL. Osteomyelitis in the diabetic foot: diagnosis and management. Med Clin North Am. 2013;97(5):947–56.

    Article  PubMed  Google Scholar 

  7. Ertugrul BM, Lipsky BA, Savk O. Osteomyelitis or Charcot neuro-osteoarthropathy? Differentiating these disorders in diabetic patients with a foot problem. Diabetic Foot Ankle 2013;https://doi.org/10.3402/dfa.v4i0.21855.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Wukich DK, Raspovic KM, Hobizal KB, Rosario B. Radiographic analysis of diabetic midfoot Charcot neuroarthropathy with and without midfoot ulceration. Foot Ankle Int. 2014;35(11):1108–15.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Hectors SJ, Besa C, Wagner M, Jajamovich GH, Haines GK 3rd, Lewis S, et al. DCE-MRI of the prostate using shutter-speed vs. Tofts model for tumor characterization and assessment of aggressiveness. J Magn Reson Imaging. 2017;46(3):837–49.

    Article  PubMed  Google Scholar 

  10. Yan S, Wang Z, Li L, Guo Y, Ji X, Ni H, et al. Characterization of cervical lymph nodes using DCE-MRI: differentiation between metastases from SCC of head and neck and benign lymph nodes. Clin Hemorheol Microcirc. 2016;64(2):213–22.

    Article  PubMed  Google Scholar 

  11. Zhang J, Zuo PL, Cheng KB, Yu AH, Cheng XG. Feasibility study of dynamic contrast enhanced magnetic resonance imaging qualitative diagnosis of musculoskeletal tumors. Beijing Da Xue Xue Bao Yi Xue Ban. 2016;48(2):287–91.

    PubMed  CAS  Google Scholar 

  12. Sujlana P, Skrok J, Fayad LM. Review of dynamic contrast-enhanced MRI: technical aspects and applications in the musculoskeletal system. J Magn Reson Imaging. 2018;47(4):875–90.

    Article  PubMed  Google Scholar 

  13. Biffar A, Sourbron S, Dietrich O, Schmidt G, Ingrisch M, Reiser MF, et al. Combined diffusion-weighted and dynamic contrast-enhanced imaging of patients with acute osteoporotic vertebral fractures. Eur J Radiol. 2010;76(3):298–303.

    Article  PubMed  Google Scholar 

  14. Lang N, Su MY, Yu HJ, Yuan H. Differentiation of tuberculosis and metastatic cancer in the spine using dynamic contrast-enhanced MRI. Eur Spine J. 2015;24(8):1729–37.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Manganaro L, Saldari M, Pozza C, Vinci V, Gianfrilli D, Greco E, et al. Dynamic contrast-enhanced and diffusion-weighted MR imaging in the characterisation of small, non-palpable solid testicular tumours. Eur Radiol. 2018;28(2):554–64.

    Article  PubMed  Google Scholar 

  16. Lipsky BA, Berendt AR, Cornia PB, Pile JC, Peters EJ, Armstrong DG, et al. 2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections. J Am Podiatr Med Assoc. 2013;103(1):2–7.

    Article  PubMed  Google Scholar 

  17. Ertugrul BM, Savk O, Ozturk B, Cobanoglu M, Oncu S, Sakarya S. The diagnosis of diabetic foot osteomyelitis: examination findings and laboratory values. Med Sci Monit. 2009;15(6):CR307–12.

    PubMed  Google Scholar 

  18. Dinh MT, Abad CL, Safdar N. Diagnostic accuracy of the physical examination and imaging tests for osteomyelitis underlying diabetic foot ulcers: meta-analysis. Clin Infect Dis. 2008;47(4):519–27.

    Article  PubMed  Google Scholar 

  19. Low KT, Peh WC. Magnetic resonance imaging of diabetic foot complications. Singapore Med J. 2015;56(01):23–34.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Fridman R, Bar-David T, Kamen S, Staron RB, Leung DK, Rasiej MJ. Imaging of diabetic foot infections. Clin Podiatr Med Surg. 2014;31(1):43–56.

    Article  PubMed  Google Scholar 

  21. Harish S, Chiavaras MM, Kotnis N, Rebello R. MR imaging of skeletal soft tissue infection: utility of diffusion-weighted imaging in detecting abscess formation. Skeletal Radiol. 2011;40(3):285–94.

    Article  PubMed  Google Scholar 

  22. Leone A, Cassar-Pullicino VN, Semprini A, Tonetti L, Magarelli N, Colosimo C. Neuropathic osteoarthropathy with and without superimposed osteomyelitis in patients with a diabetic foot. Skeletal Radiol. 2016;45(6):735–54.

    Article  PubMed  Google Scholar 

  23. Mahendra M, Singh R. Diagnostic accuracy and surgical utility of MRI in complicated diabetic foot. J Clin Diagn Res. 2017;11(7):RC01–4.

    PubMed  PubMed Central  Google Scholar 

  24. Wendl CM, Muller S, Meier J, Fellner C, Eiglsperger J, Gosau M, et al. High resolution contrast-enhanced ultrasound and 3-tesla dynamic contrast-enhanced magnetic resonance imaging for the preoperative characterization of cervical lymph nodes: first results. Clin Hemorheol Microcirc. 2012;52(2–4):153–66.

    PubMed  CAS  Google Scholar 

  25. Jansen JF, Schoder H, Lee NY, Stambuk HE, Wang Y, Fury MG, et al. Tumor metabolism and perfusion in head and neck squamous cell carcinoma: pretreatment multimodality imaging with 1H magnetic resonance spectroscopy, dynamic contrast-enhanced MRI, and [18F]FDG-PET. Int J Radiat Oncol Biol Phys. 2012;82(1):299–307.

    Article  PubMed  Google Scholar 

  26. Zhu J, Zhang F, Zhou J, Li H. Assessment of therapeutic response in Crohn's disease using quantitative dynamic contrast enhanced MRI (DCE-MRI) parameters: a preliminary study. Medicine. 2017;96(32):e7759.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Jans L, De Coninck T, Wittoek R, Lambrecht V, Huysse W, Verbruggen G, et al. 3 T DCE-MRI assessment of synovitis of the interphalangeal joints in patients with erosive osteoarthritis for treatment response monitoring. Skeletal Radiol. 2013;42(2):255–60.

    Article  PubMed  CAS  Google Scholar 

  28. Versluis B, Dremmen MH, Nelemans PJ, Wildberger JE, Schurink GW, Leiner T, et al. Dynamic contrast-enhanced MRI assessment of hyperemic fractional microvascular blood plasma volume in peripheral arterial disease: initial findings. PLoS One. 2012;7(5):e37756.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  29. Zampa V, Bargellini I, Rizzo L, Turini F, Ortori S, Piaggesi A, et al. Role of dynamic MRI in the follow-up of acute Charcot foot in patients with diabetes mellitus. Skeletal Radiol. 2011;40(8):991–9.

    Article  PubMed  Google Scholar 

  30. Abdel Razek AAK, Samir S. Diagnostic performance of diffusion-weighted MR imaging in differentiation of diabetic osteoarthropathy and osteomyelitis in diabetic foot. Eur J Radiol. 2017;89:221–5.

    Article  PubMed  Google Scholar 

  31. Demirev A, Weijers R, Geurts J, Mottaghy F, Walenkamp G, Brans B. Comparison of [18 F]FDG PET/CT and MRI in the diagnosis of active osteomyelitis. Skeletal Radiol. 2014;43(5):665–72.

    Article  PubMed  Google Scholar 

  32. Zhang M, Zhou L, Huang N, Zeng H, Liu S, Liu L. Assessment of active and inactive sacroiliitis in patients with ankylosing spondylitis using quantitative dynamic contrast-enhanced MRI. J Magn Reson Imaging. 2017;46(1):71–8.

    Article  PubMed  Google Scholar 

  33. Van Asten SA, Jupiter DC, Mithani M, La Fontaine J, Davis KE, Lavery LA. Erythrocyte sedimentation rate and C-reactive protein to monitor treatment outcomes in diabetic foot osteomyelitis. Int Wound J. 2017;14(1):142–8.

  34. Boulton AJ. The pathway to foot ulceration in diabetes. Med Clin North Am. 2013;97(5):775–90.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China

    Dan Liao, Liqiu Xie, Yongliang Han, Silin Du, Hansheng Wang, Chun Zeng & Yongmei Li

Authors
  1. Dan Liao
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Liqiu Xie
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yongliang Han
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Silin Du
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hansheng Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Chun Zeng
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yongmei Li
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yongmei Li.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Source of support

None.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Liao, D., Xie, L., Han, Y. et al. Dynamic contrast-enhanced magnetic resonance imaging for differentiating osteomyelitis from acute neuropathic arthropathy in the complicated diabetic foot. Skeletal Radiol 47, 1337–1347 (2018). https://doi.org/10.1007/s00256-018-2942-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00256-018-2942-4

Keywords

Search

Navigation