Bone marrow oedema in the diabetic foot

NewsBot · Apr 24, 2010

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Midfoot and hindfoot bone marrow oedema identified by magnetic resonance imaging in feet of subjects with diabetes and neuropathic ulceration is common but of unknown clinical significance.
Thorning C, Gedroyc WM, Tyler PA, Dick EA, Hui E, Valabhji J.
Diabetes Care. 2010 Apr 22. [Epub ahead of print]

Objectives - A retrospective cohort study assessing prevalence and clinical and radiological outcome of remote areas of bone marrow oedema on magnetic resonance imaging (MRI) in feet of subjects with diabetes and neuropathic foot ulceration.

Research design and methods - MRI performed over 6 years looking for osteomyelitis associated with neuropathic lesions were assessed for remote areas of signal change.

Results - Seventy MRI studies were assessed. Remote areas of signal change were present in 21 (30%), involved midfoot or hindfoot in 20, were associated with younger age and renal replacement therapy, and did not predict future Charcot neuroarthropathy or infection at that site. On repeat MRI in 11 with such areas, none progressed, 6 improved and 2 resolved; in 29 without, 5 developed new areas.

Conclusions - Bone marrow oedema in the midfoot and hindfoot of subjects with diabetes and neuropathic lesions is common, often transient, and of unknown significance.
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NewsBot · Apr 24, 2010

Routine MRI findings of the asymptomatic foot in diabetic patients with unilateral Charcot foot.
Poll LW, Chantelau EA.
Diabetol Metab Syndr. 2010 Apr 22;2(1):25

BACKGROUND: Imaging studies of bones in patients with sensory deficits are scarce.

Aim: to investigate bone MR images of the lower limb in diabetic patients with severe sensory polyneuropathy, and in control subjects without sensory deficits.

METHODS: Routine T1 weighted and T2-fat-suppressed-STIR-sequences without contrast media were performed of the asymptomatic foot in 10 diabetic patients with polyneuropathy and unilateral inactive Charcot foot, and in 10 matched and 10 younger, non-obese unmatched control subjects. Simultaneously, a Gadolinium containing phantom was also assessed for reference. T1 weighted signal intensity (SI) was recorded at representative regions of interest at the peritendineal soft tissue, the tibia, the calcaneus, and at the phantom. Any abnormal skeletal morphology was also recorded.

RESULTS: Mean SI at the soft tissue, the calcaneus, and the tibia, respectively, was 105%, 105% and 84% of that at the phantom in the matched and unmatched control subjects, compared to 102% (soft tissue), 112% (calcaneus) and 64% (tibia) in the patients; differences of tibia vs. calcaneus or soft tissue were highly significant (p<0.005). SI at the tibia was lower in the patients than in control subjects (p<0.05). Occult traumatic skeletal lesions were found in 8 of the 10 asymptomatic diabetic feet (none in the control feet).

CONCLUSION: MR imaging did not reveal grossly abnormal bone marrow signalling in the limbs with severe sensory polyneuropathy, but occult sequelae of previous traumatic injuries
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NewsBot · Mar 7, 2023

Bone Marrow Changes and Lesions of Diabetic Foot and Ankle Disease: Conventional and Advanced Magnetic Resonance Imaging
Gitanjali Bajaj, Avneesh Chhabra
Semin Musculoskelet Radiol. 2023 Feb;27(1):73-90

Diabetic foot and ankle complications contribute to substantial mortality and morbidity. Early detection and treatment can lead to better patient outcomes. The primary diagnostic challenge for radiologists is distinguishing Charcot's neuroarthropathy from osteomyelitis. Magnetic resonance imaging (MRI) is the preferred imaging modality for assessing diabetic bone marrow alterations and for identifying diabetic foot complications. Several recent technical advances in MRI, such as the Dixon technique, diffusion-weighted imaging, and dynamic contrast-enhanced imaging, have led to improved image quality and increased capability to add more functional and quantitative information.We discuss the bone marrow abnormalities encountered in daily radiologic assessment: osteopenia, reactive bone marrow edema-like signal, insufficiency fractures, Charcot's neuroarthropathy, osteomyelitis, serous marrow atrophy, digital ischemia, and bone infarcts, along with their pathophysiology and the conventional and advanced imaging techniques used for a comprehensive marrow evaluation.
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