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Diabetes-Related Foot Pathology High morbidity Lifetime ulcer risk - PowerPoint PPT Presentation

Diabetes-Related Foot Pathology High morbidity Lifetime ulcer risk for diabetics 25% Nearly all diabetes-related foot infection secondary from ulcer Nothing To Disclosure MRI Sensitivity & Specificity Osteomyelitis of Diabetic


  1. Diabetes-Related Foot Pathology  High morbidity  Lifetime ulcer risk for diabetics 25%  Nearly all diabetes-related foot infection secondary from ulcer

  2. Nothing To Disclosure

  3. 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

  4. 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

  5. MRI Secondary Signs  Cellulitis  Foreign body  Periosteal reacton

  6. Osteomyelitis vs. Neuropathic Charcot Osteomyelitis Neuropathic Charcot  Marrow signal change  Marrow signal change  Multiple bones  Single bone  Periarticular &  Diffuse infiltration subchondral  Minimal deformity  Deformity with bone debris  Ulcer, sinus tract, abscess  Edema but intact skin  Wgt. bearing: fore/hind  Non-wgt. bearing: foot midfoot

  7. Location, Location, Location  Neuroarthopathy (Charcot)--MIDFOOT:  Tarsal-Tarsal  Tarsometatarsal (TMT)  Osteomyelitis FORE & HINDFOOT:  Distal to tarsometatarsal  Calcaneus  Malleoli

  8. Distal phalangeal osteomyelitis Low T1 signal

  9. Distal phalangeal osteomyelitis High T2 signal

  10. Distal phalangeal osteomyelitis Gd enhancement

  11. Metatarsal head osteomyelitis with sinus tract

  12. Forefoot osteomyelitis with contiguous abscess

  13. 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

  14. Calcaneus osteomyelitis with sinus tract and abscess

  15. Osteomyelitis with intramedullary bone abscess of talus

  16. Osteomyelitis: confluent, geographic medullary distribution

  17. No osteomyelitis: Ulcer with minimal subcortical T1/T2 signal

  18. Osteomyelitis: ulcer with confluent abnomal T1 signal

  19. No osteomyelitis: T1 “hazy” pattern

  20. No osteomyelitis: T1 reticulated pattern

  21. Neuropathic arthropathy of midfoot

  22. Neuropathic arthropathy of midfoot

  23. Neuropathic arthropathy with superimposed osteomyelitis

  24. Bone Biopsy  For histological proven osteomyelitis, positive rate of percutaneous biopsy:  50%  42%  34% (largest study)

  25. Bone Biopsy  Aspiration of > 2cc’s purulent fluid—83% positive osteomyelitis rate.  Risk of seeding uninfected tissue.  Utility of identifying an organism?

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