Diagnosing osteomyelitis

NewsBot · May 22, 2018

Chronic traumatic ankle and foot osteomyelitis: a nationwide case-control study
Maryam Hosseini, Mostafa Allami, Mohammadreza Soroush, Fateme Babaha, Javad Minooeefar and Davood Rahimpoor
Military Medical Research20185:15

Background
Osteomyelitis (OM) is an atypical consequence of ankle-foot trauma which is associated with long-term mental and physical morbidity and persistent pain. This study aimed to assess the health status of OM patients with war-related ankle-foot injuries.

Methods
A total of 1129 veterans with ankle-foot injuries participated in a case-control study (2014–2016). Thirty patients with chronic OM of the ankle-foot were compared with 90 non-OM participants as the control group. Quality of life (QOL), life satisfaction and the ability to perform basic and instrumental activities of daily living were measured using the following questionnaires: short-form health survey (SF-36), satisfaction with life scale (SWLS), activity of daily living (ADL) and instrumental activity of daily living (IADL), respectively. OM patients were categorized according to their risk factors as A, B and C hosts using a modified version of the Cierny and Mader classification system. The one sample t-test, 2-independent sample t-test, ANOVA, Pearson correlation coefficient and multiple linear regression analyses were applied to analyze the data.

Results
Ankle-foot pain leading to surgery (P < 0.001) and orthosis usage (P = 0.039) were more common in OM patients. There was no significant difference between the two groups in the prevalence of pulmonary and cardiovascular diseases or kidney failure and other related diseases. OM patients showed a significantly lower level of mental health compared to non-OM respondents (P = 0.025). Approximately, 70.0% of ankle-foot injured veterans were dissatisfied with their life, and there was no difference between the two groups (P > 0.05). Mobility was significantly lower in the OM patients than in the control group (P = 0.023). Life satisfaction (P = 0.001) and the ability to perform daily activities were the determinants for poor physical (P = 0.018) and mental (P = 0.012) health-related quality of life. According to the Cierny and Mader classification system, they were all included in the type C host classification, with one major and/or three or more minor risk factors.

Conclusions
A low level of quality and satisfaction of life and ability to perform activities of daily living were observed in OM patients with war-related ankle-foot injuries. Surgeries of the ankle and foot due to pain were much more common in OM patients than in non-OM participants. Since all the participants were classified as the C-host, health policy planning seems to be necessary.
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NewsBot · Jun 5, 2018

Concordance Between Bone Pathology and Bone Culture for the Diagnosis of Osteomyelitis in the Presence of Charcot Neuro-Osteoarthropathy
Tammer Elmarsafi et al
JFAS; Article in Press

The diagnosis of osteomyelitis (OM) is a challenging but critical pathology to uncover in patients with concomitant Charcot neuro-osteoarthropathy (CN). The reference standard to diagnose OM is bone biopsy for histopathologic and microbiologic examination. The presence of CN, however, can have a negative effect on the accuracy of either method to identify OM. The aim of the present study was to examine the concordance between bone pathology and bone cultures in the presence of CN in the diagnosis of OM. A total of 286 patients with diabetes mellitus (DM) and CN were identified retrospectively, with 48 patients identified with OM. OM was confirmed by radiographs, magnetic resonance imaging, erythrocyte sedimentation rate, and C-reactive protein, positive probe-to-bone test results, and intraoperative inspection. Seventy matched pairs of bone pathology and cultures with complete data were compared and analyzed. Statistical analysis included concordance, positive predictive value, negative predictive value, sensitivity, specificity, and kappa coefficient. Concordance between bone pathology and bone culture was 41.4%, with agreement in 29 of 70 paired specimens. The diagnostic test accuracy of histopathologic examination to diagnose OM in CN bone in our study was 51.4%. The diagnostic test accuracy of microbiologic examination to diagnose OM in CN bone was 50%. The positive predictive value was 72.2%. The negative predictive value was 44.1%. The sensitivity was 57.8%. The specificity was 60.0%. The kappa coefficient was 0.165. The reference standard method of histopathologic and microbiologic examination of bone specimens has little concordance and can lead to inaccurate or inconclusive information. The low sensitivity and specificity demonstrated in the present study does not support the use of the current reference standard method of bone biopsy for histologic and microbiologic diagnosis of OM when CN is present. Thus, a diagnosis of OM in patients with CN should only be considered in the presence of strong clinical, laboratory, and imaging correlates.
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NewsBot · Sep 2, 2018

Level of Agreement With a Multi-Test Approach to the Diagnosis of Diabetic Foot Osteomyelitis
Andrew J. Meyr, DPM et al
JFAS; Article in Press

Although bone biopsy has historically been considered the “gold standard” or “standard reference” for the diagnosis of diabetic foot osteomyelitis, some contemporary investigations have provided evidence against this as a single diagnostic test and in support of a combination of clinical, laboratory, and radiographic findings. The objective of this investigation was to measure the level of agreement between several commonly used forms of diagnostic testing for diabetic foot osteomyelitis. A retrospective chart review was performed of 50 consecutive patients admitted to a single tertiary healthcare center with the documented performance of 1) a clinical probe-to-bone test on hospital admission; 2) plain film radiographs prior to any surgical intervention; 3) magnetic resonance imaging prior to any surgical intervention; and an intraoperative excisional bone debridement performed, with samples sent for both 4) histologic analysis and 5) microbiologic analysis. A frequency count of agreement among these 5 tests was performed, and the interobserver (or inter-test) agreement was measured using the kappa statistic. We observed low levels of inter-test agreement between the 5 diagnostic tests (range 42.0%–62.0%), and levels of chance-corrected agreement were well below what would be considered appropriate for a “gold standard” or “standard reference.” Levels of the kappa statistic ranged from 0.0 to 0.220, with most inter-test comparisons falling in the “poor agreement” and “slight agreement” interpretation ranges. The highest level of agreement occurred between the plain film radiographs and magnetic resonance imaging (62.0% agreement and kappa statistic of 0.220). Although it is likely that a combination of clinical, radiographic, and laboratory tests provides the best diagnostic approach for diabetic foot osteomyelitis, the data provided herein indicate that the tests themselves might have high intrinsic levels of unreliability and that the specific combination of tests that might be best used remains unclear.
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NewsBot · Oct 3, 2018

Toe ulcers and early diagnosis of osteomyelitis in diabetic patients
Maria Gala Santini Araujo, MD, Pablo Sotelano, MD, Nelly Carrasco, MD, Ana Parise , MD, Daniel Villena, MD
AOFAS Annual Meeting 2018 1

Introduction/Purpose: Neuropathy and Peripheral arterial disease are the main causes of diabetic foot ulcers. Toes are the
most frequent location. Osteomyelitis diagnosis of foot ulcers is still controversial, mainly in ulcers without bone exposure.
Although MRI has 90% sensitivity and 85% specificity for osteomyelitis diagnosis, it is not usually used for early detection of bone
changes, due to lack of availability and high cost. Bone biopsy puncture is considered the gold standard methodology together
with microbiological and histological examinations, but it is not always available in all practices.
The purpose of this study was to describe the diagnosis in forefoot ulcers found in diabetic patients using MRI and bone biopsy
puncture.
Methods: This is a retrospective study, a case series. Clinical records of patients with injuries limited to toes between January
2013 and December 2015 were analyzed. The inclusion criteria were: patients with Diabetes Mellitus ( DM) diagnosis and with a
grade 1 or 2 digital ulcer according to Wagner’s classification for at least 3 weeks, with visible bone edema in the magnetic
resonance (MRI) and those with a bone biopsy performed, and with a minimum follow –up of a year.
Patients with diabetic foot ulcers were evaluated by an interdisciplinary team. Laboratory standards were evaluated preoperative
and during antibiotic therapy. The surgical bone biopsy was performed by a foot and ankle surgeon with experience in Diabetic
foot pathologies. Microbiological and histological study was analyzed. We also recorded the demographic data and identified the
patients who had received previous empiric antibiotic therapy. Statistical analysis was performed.
Results: Thirty patients out of 93 patients fulfilled inclusion criteria between January 2013 and December 2015. Eleven patients
had grade 1 ulcers and 19 grade 2.
Twenty-two patients (73.3%) got bone biopsies with positive cultures and 14 (63,3%) had a positive pathological anatomy.
Eight patients got negative cultures and pathology.
Six patients that did not received empiric antibiotic therapy and 19 patients out of 24 who had received empiric antibiotics had
positive cultures.
Mean healing time for patients who did not had antibiotics was 4 weeks (3-12) and for the group who received empiric antibiotics
was 6 weeks (4-10/)
Only 4 patients out of 19 patients with Wagner II ulcers had the toe amputated.
Conclusion: A precise diagnosis of the germ was obtained in 73.3% of the patients and a specific antibiotic treatment was
completed. Although empiric antibiotic therapy 19 out of 24 patients had positive bone cultures and healing time was longer.
Amputation index was 13%, all of them were grade 2 ulcers. There were no major amputations.
We consider that in these kind of ulcers that had more than 3 weeks without healing and had no radiographic changes, MRI can
show bone edema. Surgical bone biopsy should be done to begin specific antibiotic therapy and improve healing time.
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NewsBot · Jan 25, 2019

Diagnostic Utility of Erythrocyte Sedimentation Rate and C-Reactive Protein in Osteomyelitis of the Foot in Persons Without Diabetes
Easton C. Ryan et al
JFAS; Article in Press

The aim of the study was to assess the diagnostic value of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels in differentiating foot osteomyelitis (OM) from soft tissue infection (STI) in persons without diabetes. We evaluated 102 patients in a retrospective cohort study of nondiabetic patients admitted to our institution with OM (n = 51) and with STI (n = 51). Patient diagnosis was determined through bone culture and/or histopathology for OM and magnetic resonance scan and/or single-photon emission computed tomography for STI. Cutoffs for ESR and CRP to predict OM as identified by receiver operating characteristic were 45.5 mm/h and 3.45 mg/dL, respectively. The ESR cutoff demonstrated a sensitivity and specificity of 49% and 79%, while the values for CRP were 45% and 71%, respectively. The combined sensitivity and specificity for ESR and CRP were 33% and 84%. The positive and negative predictive values were 68% and 60% for ESR and 61% and 56% for CRP, respectively. In conclusion, ESR and CRP demonstrate poor sensitivity and specificity for detecting OM in the nondiabetic foot. These markers have little diagnostic utility in the nondiabetic foot.
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NewsBot · Apr 3, 2019

Applicability of histopathological osteomyelitis evaluation score (HOES) in chronic osteomyelitis of the foot — A feasibility study
Tatiana AnatolievnaStupinaaAnatoliy SergeyevichSudnitsynbKoushik NarayanSubramanyamcNikolai SergeevichMigalkinaAnastasia YrievnaKirsanovaaSagarUmerjikarc
Foot and Ankle Surgery; 2 April 2019

Highlights
•Validation Histopathological Osteomyelitis Evaluation Score in foot osteomyelitis.
•Gross disparity between clinical and pathological diagnoses of type of osteomyelitis.
•Study yields three distinct pathological entities of chronic osteomyelitis.
•HOES score shows good intra- and inter-observer reliability.
•Further studies needed to look for clinical significance.
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Background
Diagnosis and classification of chronic osteomyelitis is not based on any objective criteria. None of the available methods for this is completely reliable. Tienmann et al. (2014) has described the so called Histopathological Osteomyelitis Evaluation Score (HOES) to overcome this limitation. But this has not been externally validated or tested in cases with foot osteomyelitis.

Methods
We prospectively reviewed the histopathological samples of 30 consecutive patients (30 feet) with foot osteomyelitis managed operatively. There were 19 males and 11 females with an average age of 41.6 (range, 27 to 63) years. The underlying pathology was spina bifida in 12, Charcot’s arthropathy in eleven and post-traumatic in seven patients. The bones involved were calcaneum, talus and fifth metatarsal. Pathological diagnosis was made based on HOES by a single pathologist blinded to the clinical diagnosis and both were compared. Intra- and inter-observer reliability of HOES was assessed by analysing the scores of each patient assigned independently by four different pathologists (blinded to the clinical diagnoses and to each other) at two different occasions one week apart.

Results
All samples showed features of long-standing osteomyelitis. When attempting to classify to “acute on chronic”, “chronic” and “quiescent” forms, the pathological diagnosis correlatead with the clinical diagnosis only in 16 cases (53.3 percent). Histological classification to Tienmann’s types as per the scoring system yielded three distinct pathological entities that had common histological features with regard to bone, soft tissue and inflammatory infiltration. HOES exhibited excellent intra- and inter-observer reliability.

Conclusions
HOES is well applicable in foot osteomyelitis both for diagnosis and classification by unambiguous and precise scoring system. This makes diagnostic labelling more accurate and repeatable. The clinical relevance of these histopathological types in guiding management and determining prognosis needs to be investigated further.
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NewsBot · Jul 25, 2019

What Is the Optimal Method to Perform Bone Biopsy (Method, Location, Imaging Use) for Patients With Foot and Ankle Infections?
Joseph T. O’Neil, MD
July 19, 2019

Recommendation:
A bone biopsy should generally be performed in a percutaneous fashion, particularly in cases where surgical debridement is not considered necessary.

If surgical debridement is considered necessary, then an open biopsy can be performed as part of the debridement.

Percutaneous biopsy should be performed under sterile conditions by an interventional radiologist or other physician trained in image-guided techniques.

The location of the biopsy will depend upon the clinical and radiographic evaluations, with a goal of maximizing the yield of the biopsy while minimizing the risk of injury to surrounding and/or overlying soft tissue structures
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NewsBot · Sep 5, 2019

Inflammatory markers limitations in the diagnosis of pediatric calcaneal osteomyelitis.
Ingersoll J et al
Am J Emerg Med. 2019 Aug 24:158416

Calcaneal osteomyelitis is an uncommon, but clinically important emergent condition in the differential of the limping child. Early recognition is paramount to prevent complications from delayed diagnosis like formation of periosteal abscesses or growth plate injury. The diagnosis of pediatric osteoarticular infection relies on a combination of clinical exam, imaging and inflammatory markers. Erythrocyte sedation rate (ESR) and C-reactive protein (CRP) have reported sensitivities for osteomyelitis of 94% and 95%, respectively. However, clinicians should be aware that certain clinical factors can decrease the reliability of inflammatory markers in this pediatric condition. Location of infection in small bones like the calcaneus can lead to significantly lower sensitivities than in long bones. Pretreatment with antibiotics prior presentation can also decrease the reliability of ESR and CRP. In this case, we highlight two unique clinical factors that diminish the sensitivity of commonly used inflammatory markers in the diagnosis of pediatric osteomyelitis.
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NewsBot · Jan 20, 2020

Role of inflammatory markers in the healing time of diabetic foot osteomyelitis treated by surgery or antibiotics
Aroa Tardáguila-García, Yolanda García-Álvarez, Irene Sanz-Corbalán, Francisco Javier Álvaro-Afonso, Raúl Juan Molines-Barroso, José Luis Lázaro-Martínez
Journal of Wound CareVol. 29, No. 1

Objective:
To analyse the predictive role of inflammatory markers in the healing time of diabetic foot osteomyelitis treated by surgery or antibiotics.

Methods:
An observational study of patients with diabetic foot ulcers (DFU) and clinically suspected osteomyelitis. The patients underwent surgical or antibiotic treatment for bone infection in a specialised diabetic foot unit. Blood samples were taken from each patient to analyse biomarkers. The main outcome was the number of weeks until healing occurred.

Results:
A total of 116 patients took part in the study. The number of weeks until healing was similar for both groups (surgical n=96 and antiobiotic n=20, treatments). No association was observed among biomarkers as predictors of time-to-healing.

Conclusion:
There is not enough evidence to define the prognostic role of inflammatory markers in the healing time of DFUs complicated with diabetic foot osteomyelitis, regardless of the treatment administered
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NewsBot · Sep 1, 2020

Imaging for detection of osteomyelitis in people with diabetic foot ulcers: A systematic review and meta-analysis
Alexis Llewellyn et al
Eur J Radiol. 2020 Aug 13

Background: Osteomyelitis is an infection of the bone which can occur in people with diabetic foot ulcers. It can be diagnosed using X-rays, ultrasound, scintigraphy, magnetic resonance imaging (MRI), single photon emission computed tomography (SPECT) and positron emission tomography (PET).

Objectives: To review the evidence on the diagnostic accuracy of imaging tests to diagnose osteomyelitis in people with diabetic foot ulcers.

Methods: We conducted a systematic review and meta-analysis. MEDLINE, EMBASE and other databases were searched to July 2018. Risk of bias was evaluated. Diagnostic accuracy was estimated using bivariate meta-analyses.

Results: Thirty-six studies were included in the meta-analysis. Eight studies were at high risk of bias MRI had high diagnostic accuracy (22 studies: 96.4 % sensitivity (95 % CI 90.7-98.7); 83.8 % specificity (76.0-89.5)). PET scans also had high accuracy (6 studies: 84.3 % sensitivity (52.8-96.3); 92.8 % specificity (75.7-98.2)), and possibly also SPECT, but with few studies (3 studies: 95.6 % sensitivity (76.0-99.3); 55.1 % specificity (19.3-86.3)). Scintigraphy (17 studies: 84.2 % sensitivity (76.8-89.6); 67.7 % specificity (56.2-77.4)), and X-rays (16 studies: 61.9 % sensitivity (50.5-72.1); 78.3 % specificity (62.9-88.5)) had generally inferior diagnostic accuracy.

Conclusions: MRI and PET both reliably diagnose osteomyelitis in diabetic foot ulcer patients. SPECT may also have good diagnostic accuracy, although evidence is limited. This review confirms most current guidelines, showing that MRI may be the preferable test in most cases, given its wider availability and the lack of potentially harmful ionising radiation.
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NewsBot · Nov 6, 2020

Are surrogate markers for diabetic foot osteomyelitis remission reliable?
Peter A Crisologo, Matthew Malone, Javier La Fontaine, Orhan Oz, Kavita Bhavan, Adam Nichols, Lawrence A Lavery
J Am Podiatr Med Assoc. 2020 Nov 2;20-147

Background: The aim of this study was to evaluate surrogate markers commonly used in the literature for diabetic foot osteomyelitis remission after initial treatment for diabetic foot infections.

Methods: Thirty-five patients with diabetic foot infections were prospectively enrolled and followed for 12 months. Osteomyelitis was determined from bone culture and histology initially and for recurrence. Chi square and Fischer's exact test were used for dichotomous variables and the student's t-test and Mann-Whitney U test for continuous variables with an alpha of 0.05.

Results: Twenty-four patients were diagnosed with osteomyelitis and eleven patients with soft-tissue infections. 16.7% (n=) of patients with osteomyelitis had a re-infection based on bone biopsy. The success of osteomyelitis treatment varied based on the surrogate marker used to define remission: osteomyelitis infection (16.7%), failed wound healing (8.3%), re-ulceration (20.8%), re-admission (16.7%), amputation (12.5%). There was no difference in outcomes among patients who were initially diagnosed with osteomyelitis and soft tissue infections. There were no differences in osteomyelitis re-infection (16.7% vs 45.5%, p=0.07), wounds that failed to heal (8.3% vs 9.1%, p=0.94), re-ulceration (20.8% vs 27.3%, p=0.67), re-admission for diabetic foot infections at the same site (16.7% vs 36.4%, p=0.20), amputation at the same site after discharge (12.5% vs 36.4%, p=0.10). Osteomyelitis at the index site based on bone biopsy indicated that failed therapy was 16.7%. Indirect markers demonstrated a failure rate ranging from 8.3-20.8%.

Conclusions: Most osteomyelitis markers were similar to markers in soft tissue infection subjects. Commonly reported surrogate markers were not shown to be specific to identify patients that failed osteomyelitis treatment when compared with patients that had soft tissue infections. Given this, these surrogate markers are not reliable for use in practice to identify osteomyelitis treatment failure.
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NewsBot · Nov 18, 2020

Magnetic Resonance Imaging of Diabetic Foot Osteomyelitis: Imaging Accuracy in Biopsy-Proven Disease
Javier La Fontaine et al
JFAS: November 17, 2020

Magnetic resonance imaging (MRI) is the recommended diagnostic imaging technique for diabetic foot osteomyelitis (DFO). The gold standard to diagnose osteomyelitis is bone biopsy with a positive culture and/or histopathology finding consistent with osteomyelitis. The purpose of this study is to assess the accuracy of MRI readings in biopsy-proven diabetic foot osteomyelitis with a second read done by a blinded, expert musculoskeletal radiologist. A retrospective chart review of 166 patients who received a bone biopsy to confirm the diagnosis of a suspected DFO at a large county hospital between 2010 and 2014. A second, blinded musculoskeletal radiologist reviewed the images for accuracy, once the official reading was recorded. Imaging results were correlated with the final diagnosis of osteomyelitis determined by bone biopsy. In 17 of 58 patients (29.3%), the diagnosis of DFO by MRI was not confirmed by bone biopsy. There were 12 false positives and 5 false negatives. After the second expert read, there were 5 false positives and 4 false negatives. The overall accuracy was 84% for the second read. Our study demonstrated results comparable to the previously reported meta-analysis findings. There is a clear variation on the read of MRI that could lead to an incorrect diagnosis of DFO. An integrated approach with evaluation of clinical findings, communication with radiologist about the MRI results when indicated, and bone biopsy is warranted for accurate diagnosis management of DFO.
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NewsBot · Sep 19, 2022

Ultrasonographic features of diabetic foot osteomyelitis: a case series
Adam Astrada et al
J Wound Care. 2022 Sep 2;31(9):748-754

Objective: Osteomyelitis is a limb-threatening complication of diabetic foot ulcers. Early identification of the disease is key to ensuring successful prognosis. In this study, we describe ultrasonographic features for the identification of osteomyelitis.

Method: Patients were screened through clinical, ultrasonographic and probe-to-bone tests.

Results: Ultrasonographic features in three patients that could be used to identify diabetic foot osteomyelitis included periosteal reaction, periosteal elevation, cortical erosions and presence of sequestrum, all of which were confirmed by a plain X-ray.

Conclusion: An ultrasonographic examination could be used for the early detection of osteomyelitis, which could help clinicians devise prompt treatment strategies.
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NewsBot · Nov 14, 2023

Diagnostic performance of ultrasonography for diabetic foot osteomyelitis
Mateo López-Moral et al
Adv Wound Care (New Rochelle). 2023 Nov 11

Objective: This study aims to analyze the potential diagnostic capability of ultrasonography in detecting diabetic foot osteomyelitis (DFO) in patients with diabetic foot ulcers (DFUs).

Approach: A 1-year prospective study was conducted on 47 consecutive patients with active DFUs and suspicion of DFO at a specialized diabetic foot unit. The following ultrasonographic (US) features were evaluated at baseline: 1) periosteal reaction; 2) periosteal elevation; 3) cortical disruption; 4) sequestrum; and 5) positive power Doppler. Primary outcome measure aimed to establish the effectiveness of ultrasonographic features compared to aseptic bone culture for diagnosing DFO. Receiver operating characteristic (ROC) curves were utilized to evaluate the diagnostic performance of the ultrasonographic features. Sample size could not be performed as it becomes the first study to assess US features for the diagnosis of DFO. The research adhered to the guidelines for diagnostic accuracy studies (STARD 2015).

Results: All patients (n=24) diagnosed with DFO exhibited positive power Doppler, resulting in a sensitivity (S) and specificity (SP) of 1 and an area under the curve (AUC) of 1 (P <0.001 [1-1]). Cortical disruption was present in 23 patients (95.8%) with DFO, yielding an S of 0.93, SP of 1, and an AUC of 0.96 (P <0.001 [0.88-1]).

Innovation: It validates the diagnostic value of US for DFO, as it is the first and largest study of its kind to establish a clear reference standard to guide clinician decision-making.

Conclusion: This study demonstrates the effectiveness of cortical disruption and positive power Doppler in assessing DFO through ultrasonography.
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NewsBot · Jan 12, 2024

How to do and evaluate DWI and DCE-MRI sequences for diabetic foot assessment
Teodoro Martín-Noguerol et al
Skeletal Radiol. 2023 Nov 25

MRI evaluation of the diabetic foot is still a challenge not only from an interpretative but also from a technical point of view. The incorporation of advanced sequences such as diffusion-weighted imaging (DWI) and dynamic contrast-enhanced (DCE) MRI into standard protocols for diabetic foot assessment could aid radiologists in differentiating between neuropathic osteoarthropathy (Charcot's foot) and osteomyelitis. This distinction is crucial as both conditions can coexist in diabetic patients, and they require markedly different clinical management and have distinct prognoses. Over the past decade, several studies have explored the effectiveness of DWI and dynamic contrast-enhanced MRI (DCE-MRI) in distinguishing between septic and reactive bone marrow, as well as soft tissue involvement in diabetic patients, yielding promising results. DWI, without the need for exogenous contrast, can provide insights into the cellularity of bone marrow and soft tissues. DCE-MRI allows for a more precise evaluation of soft tissue and bone marrow perfusion compared to conventional post-gadolinium imaging. The data obtained from these sequences will complement the traditional MRI approach in assessing the diabetic foot. The objective of this review is to familiarize readers with the fundamental concepts of DWI and DCE-MRI, including technical adjustments and practical tips for image interpretation in diabetic foot cases
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NewsBot · Jan 17, 2024

State of the art in the diagnostic evaluation of osteomyelitis: exploring the role of advanced MRI sequences-a narrative review
Arosh S Perera Molligoda Arachchige, Yash Verma
Quant Imaging Med Surg. 2024 Jan 3;14(1):1070-1085

Background and objective: Osteomyelitis, a severe bone infection caused mainly by pyogenic organisms, poses diagnostic challenges due to its non-specific magnetic resonance imaging (MRI) manifestations. Conventional MRI, though the imaging modality of choice, often exhibits signal abnormalities with overlapping differential diagnoses, potentially leading to overestimation of infection extent and duration. To address these limitations, advanced MRI sequences, including dynamic contrast-enhanced (DCE) MRI, 1H magnetic resonance spectroscopy (MRS), diffusion-weighted imaging (DWI), and Dixon techniques have emerged as promising alternatives. This narrative review explores the potential role of these sequences in aiding the differential diagnosis of osteomyelitis.

Methods: We used the PubMed database to search for relevant articles using the MeSH keywords: (osteomyelitis) AND (advanced MRI sequences) and we manually selected the most suitable studies to include in our review. Articles outside of original studies were also included. Only records in English or French were considered.

Key content and findings: In particular, DWI is useful for characterizing fluid collections, distinguishing bone infarcts, and bacterial skull base osteomyelitis from neoplastic lesions. Moreover, DWI assists in differentiating diabetic foot osteomyelitis (DFO) from Charcot neuro-osteoarthropathy, facilitates the diagnosis of pediatric acute osteoarticular infections, and aids in distinguishing osteomyelitis from Modic I degenerative changes. Additionally, DWI proves valuable in monitoring spinal infections and distinguishing pedal osteomyelitis from other conditions, even in patients with renal impairment. DCE-MRI enhances MRI specificity by assessing contrast uptake over time, providing valuable insights into inflammatory microenvironments. It aids in detecting DFO, differentiating it from acute Charcot arthropathy, and distinguishing osteomyelitis from neuropathic arthropathy. Moreover, DCE-MRI shows potential in assessing response to antibiotic therapy in spinal infections. Dixon acquisition improves image quality and facilitates the detection of bone marrow abnormalities, aiding in the differentiation of diabetic foot from osteomyelitis. It also assists in distinguishing osteomyelitis from neuropathic arthropathy and provides valuable information in evaluating the diabetic foot. Proton MR spectroscopy, a well-established modality, offers metabolic information that can differentiate malignant from benign lesions.

Conclusions: The role of advanced MRI techniques in evaluating osteomyelitis remains to be fully defined, and further research is required to explore its potential utility in this context. In conclusion, the incorporation of advanced MRI sequences has shown promise in improving the differential diagnosis of osteomyelitis. Future investigations exploring combinations of these techniques and their clinical applications hold significant potential to enhance diagnostic accuracy and patient outcomes.
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Diagnosing osteomyelitis

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Probe-to-Bone Test for Diagnosing Diabetic Foot Osteomyelitis

Magnetic Resonance Imaging for Diagnosing Foot Osteomyelitis

Diagnosing plantar warts

Diagnosing achilles tendon problems

Patients diagnosing themselves

Wound fluid lactate concentration: a helpful marker for diagnosing soft-tissue infection in diabetic

Diagnosing diabetes

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Diagnosing osteomyelitis

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Probe-to-Bone Test for Diagnosing Diabetic Foot Osteomyelitis

Magnetic Resonance Imaging for Diagnosing Foot Osteomyelitis

Diagnosing plantar warts

Diagnosing achilles tendon problems

Patients diagnosing themselves

Wound fluid lactate concentration: a helpful marker for diagnosing soft-tissue infection in diabetic

Diagnosing diabetes

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