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Semin Musculoskelet Radiol 2004; 8(3): 189-198
DOI: 10.1055/s-2004-835359
Copyright © 2004 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001 USA.

MR Imaging of Diabetic Foot Infection

Holly C. Gil1 , William B. Morrison1
  • 1Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA
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Publication History

Publication Date:
11 October 2004 (online)

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Infection of the foot is common, especially in the diabetic population. Over the past decade, magnetic resonance imaging (MRI) has become a ‘gold standard’ for evaluation of pedal infection. Therefore it is important for the radiologist to understand the MRI appearance of various manifestations of infection as well as conditions that may simulate infection, including neuropathic disease.

KEYWORDS

Infection - diabetes - MR imaging - foot - charcot

REFERENCES

  • 1 Lipsky B A, Pecoraro R E, Wheat L J. The diabetic foot. Soft tissue and bone infection.  Infect Dis Clin North Am. 1990;  4 409-432
    PubMedSearch in Google Scholar
  • 2 Ledermann H P, Schweitzer M E, Morrison W B. Nonenhancing tissue on MR imaging of pedal infection: characterization of necrotic tissue and associated limitations for diagnosis of osteomyelitis and abscess.  AJR. 2002;  178 215-222
    PubMedSearch in Google Scholar
  • 3 Jeffcoate W, Lima J, Nobrega L. The Charcot foot.  Diabet Med. 2000;  17 253-258
    CrossrefPubMedSearch in Google Scholar
  • 4 Johnson J T. Neuropathic fractures and joint injuries. Pathogenesis and rationale of prevention and treatment.  J Bone Joint Surg. 1967;  49 1-30
    PubMedSearch in Google Scholar
  • 5 Sella E J, Barrette C. Staging of Charcot neuroarthropathy along the medial column of the foot in the diabetic patient.  J Foot Ankle Surg. 1999;  38 34-40
    CrossrefPubMedSearch in Google Scholar
  • 6 Lower R F, Kenzora J E. The diabetic neuropathic foot: a triple crush syndrome-measurement of compartmental pressures of normal and diabetic feet.  Orthopedics. 1994;  17 241-248
    PubMedSearch in Google Scholar
  • 7 Smith D M, Weinberger M, Katz B P. A controlled trial to increase office visits and reduce hospitalizations of diabetic patients.  J Gen Intern Med. 1987;  2 232-238
    PubMedSearch in Google Scholar
  • 8 Humphrey L L, Palumbo P J, Butters M A et al.. The contribution of non-insulin-dependent diabetes to lower-extremity amputation in the community.  Arch Intern Med. 1994;  154 885-892
    CrossrefPubMedSearch in Google Scholar
  • 9 Most R S, Sinnock P. The epidemiology of lower extremity amputations in diabetic individuals.  Diabetes Care. 1983;  6 87-91
    CrossrefPubMedSearch in Google Scholar
  • 10 Apelqvist J, Ragnarson-Tennvall G, Persson U et al.. Diabetic foot ulcers in a multidisciplinary setting. An economic analysis of primary healing and healing with amputation.  J Intern Med. 1994;  235 463-471
    CrossrefPubMedSearch in Google Scholar
  • 11 Goldner M G. The fate of the second leg in the diabetic amputee.  Diabetes. 1960;  9 100-103
    CrossrefPubMedSearch in Google Scholar
  • 12 Hoar C S, Torres J. Evaluation of below-the-knee amputation in the treatment of diabetic gangrene.  N Engl J Med. 1962;  266 440-443
    PubMedSearch in Google Scholar
  • 13 Pell J P, Donnan P T, Fowkes F G et al.. Quality of life following lower limb amputation for peripheral arterial disease.  Eur J Vasc Surg. 1993;  7 448-451
    CrossrefPubMedSearch in Google Scholar
  • 14 Dangman B C, Hoffer F A, Rand F F et al.. Osteomyelitis in children: gadolinium-enhanced MR imaging.  Radiology. 1992;  182 743-747
    PubMedSearch in Google Scholar
  • 15 Hopkins K L, Li K C, Bergman G. Gadolinium-DTPA-enhanced magnetic resonance imaging of musculoskeletal infectious processes.  Skeletal Radiol. 1995;  24 325-330
    PubMedSearch in Google Scholar
  • 16 Morrison W B, Schweitzer M E, Bock G W et al.. Diagnosis of osteomyelitis: utility of fat-suppressed contrast-enhanced MR imaging.  Radiology. 1993;  189 251-257
    CrossrefPubMedSearch in Google Scholar
  • 17 Lavery L A, Armstrong D G, Vela S A, Quebedeaux T L, Fleischli J G. Practical criteria for screening patients at high risk for diabetic foot ulceration.  Arch Intern Med. 1998;  158 157-162
    CrossrefPubMedSearch in Google Scholar
  • 18 Levin M E. Foot lesions in patients with diabetes mellitus.  Endocrinol Metab Clin North Am. 1996;  25 447-462
    CrossrefPubMedSearch in Google Scholar
  • 19 Sumpio B E. Foot ulcers.  N Engl J Med. 2000;  343 787-793
    CrossrefPubMedSearch in Google Scholar
  • 20 Morrison W B, Schweitzer M E, Batte W G et al.. Osteomyelitis of the foot: relative importance of primary and secondary MR imaging signs.  Radiology. 1998;  207 625-632
    CrossrefPubMedSearch in Google Scholar
  • 21 Stadelmann W K, Digenis A G, Tobin G R. Impediments to wound healing.  Am J Surg. 1998;  176 39S-47S
    PubMedSearch in Google Scholar
  • 22 Lipsky B A. Osteomyelitis of the foot in diabetic patients.  Clin Infect Dis. 1997;  25 1318-1326
    CrossrefPubMedSearch in Google Scholar
  • 23 Tang J S, Gold R H, Bassett L W et al.. Musculoskeletal infection of the extremities: evaluation with MR imaging.  Radiology. 1988;  166 205-209
    PubMedSearch in Google Scholar
  • 24 Unger E, Moldofsky P, Gatenby R et al.. Diagnosis of osteomyelitis by MR imaging.  AJR. 1988;  150 605-610
    PubMedSearch in Google Scholar
  • 25 Beltran J, Campanini D S, Knight C et al.. The diabetic foot: magnetic resonance imaging evaluation.  Skeletal Radiol. 1990;  19 37-41
    PubMedSearch in Google Scholar
  • 26 Cook T A, Rahim N, Simpson H C et al.. Magnetic resonance imaging in the management of diabetic foot infection.  Br J Surg. 1996;  83 245-248
    CrossrefPubMedSearch in Google Scholar
  • 27 Croll S D, Nicholas G G, Osborne M A et al.. Role of magnetic resonance imaging in the diagnosis of osteomyelitis in diabetic foot infections.  J Vasc Surg. 1996;  24 266-270
    CrossrefPubMedSearch in Google Scholar
  • 28 Paajanen H, Grodd W, Revel D et al.. Gadolinium-DTPA enhanced MR imaging of intramuscular abscesses.  Magn Reson Imaging. 1987;  5 109-115
    PubMedSearch in Google Scholar
  • 29 Boutin R D, Brossmann J, Sartoris D J et al.. Update on imaging of orthopedic infections.  Orthop Clin North Am. 1998;  29 41-66
    CrossrefPubMedSearch in Google Scholar
  • 30 Jaovisidha S, Chen C, Ryu K N et al.. Tuberculous tenosynovitis and bursitis: imaging findings in 21 cases.  Radiology. 1996;  201 507-513
    CrossrefPubMedSearch in Google Scholar
  • 31 Brower A C. Septic arthritis.  Radiol Clin North Am. 1996;  34 293-309
    PubMedSearch in Google Scholar
  • 32 Ledermann H P, Morrison W B, Schweitzer M E. MR analysis of pedal osteomyelitis: distribution, patterns of spread and frequency of associated ulceration and septic arthritis.  Radiology. 2002;  223 747-755
    CrossrefPubMedSearch in Google Scholar
  • 33 Graif M, Schweitzer M E, Deely D et al.. The septic versus nonseptic inflamed joint: MRI characteristics.  Skeletal Radiol. 1999;  28 616-620
    CrossrefPubMedSearch in Google Scholar
  • 34 Capitanio M A, Kirkpatrick J A. Early roentgen observations in acute osteomyelitis.  Am J Roentgenol Radium Ther Nucl Med. 1970;  108 488-496
    CrossrefPubMedSearch in Google Scholar
  • 35 David R, Barron B J, Madewell J E. Osteomyelitis, acute and chronic.  Radiol Clin North Am. 1987;  25 1171-1201
    PubMedSearch in Google Scholar
  • 36 Schauwecker D S, Braunstein E M, Wheat L J. Diagnostic imaging of osteomyelitis.  Infect Dis Clin North Am. 1990;  4 441-463
    PubMedSearch in Google Scholar
  • 37 Armstrong D G, Todd W F, Lavery L A, Harkless L B, Bushman T R. The natural history of acute Charcot's arthropathy in a diabetic foot specialty clinic.  Diabet Med. 1997;  14 357-363
    CrossrefPubMedSearch in Google Scholar
  • 38 Clouse M E, Gramm H F, Legg M et al.. Diabetic osteoarthropathy. Clinical and roentgenographic observations in 90 cases.  Am J Roentgenol Radium Ther Nucl Med. 1974;  121 22-34
    CrossrefPubMedSearch in Google Scholar
  • 39 Cofield R H, Morrison M J, Beabout J W. Diabetic neuroarthropathy in the foot: patient characteristics and patterns of radiographic change.  Foot Ankle. 1983;  4 15-22
    PubMedSearch in Google Scholar
  • 40 Schon L C, Easley M E, Weinfeld S B. Charcot neuroarthropathy of the foot and ankle.  Clin Orthop. 1998;  349 116-131
    PubMedSearch in Google Scholar
  • 41 Crim J R, Seeger L L. Imaging evaluation of osteomyelitis.  Crit Rev Diagn Imaging. 1994;  35 201-256
    PubMedSearch in Google Scholar
  • 42 Israel O, Gips S, Jerushalmi J et al.. Osteomyelitis and soft-tissue infection: differential diagnosis with 24 hour/4 hour ratio of Tc-99m MDP uptake.  Radiology. 1987;  163 725-726
    PubMedSearch in Google Scholar
  • 43 Keenan A M, Tindel N L, Alavi A. Diagnosis of pedal osteomyelitis in diabetic patients using current scintigraphic techniques.  Arch Intern Med. 1989;  149 2262-2266
    CrossrefPubMedSearch in Google Scholar
  • 44 Alazraki N, Dries D, Datz F et al.. Value of a 24-hour image (four-phase bone scan) in assessing osteomyelitis in patients with peripheral vascular disease.  J Nucl Med. 1985;  26 711-717
    PubMedSearch in Google Scholar
  • 45 Park H M, Wheat L J, Siddiqui A R et al.. Scintigraphic evaluation of diabetic osteomyelitis: concise communication.  J Nucl Med. 1982;  23 569-573
    PubMedSearch in Google Scholar
  • 46 Gold R H, Tong D J, Crim J R et al.. Imaging the diabetic foot.  Skeletal Radiol. 1995;  24 563-571
    PubMedSearch in Google Scholar
  • 47 Maurer A H, Millmond S H, Knight L C et al.. Infection in diabetic osteoarthropathy: use of indium-labeled leukocytes for diagnosis.  Radiology. 1986;  161 221-225
    PubMedSearch in Google Scholar
  • 48 Goodwin D W, Salonen D C, Yu J S et al.. Plantar compartments of the foot: MR appearance in cadavers and diabetic patients.  Radiology. 1995;  196 623-630
    PubMedSearch in Google Scholar
  • 49 Moore T E, Yuh W T, el Khoury G Y. Plantar compartments of the foot: MR appearance in cadavers and diabetic patients.  Radiology. 1996;  198 909
    PubMedSearch in Google Scholar
  • 50 Yu J S. Diabetic foot and neuroarthropathy: magnetic resonance imaging evaluation.  Top Magn Reson Imaging. 1998;  9 295-310
    PubMedSearch in Google Scholar
  • 51 Marcus C D, Ladam-Marcus V J, Leone J et al.. MR imaging of osteomyelitis and neuropathic osteoarthropathy in the feet of diabetics.  Radiographics. 1996;  16 1337-1348
    CrossrefPubMedSearch in Google Scholar
  • 52 Nguyen V D. The radiologic spectrum of abnormalities of the foot in diabetic patients.  Can Assoc Radiol J. 1992;  43 333-339
    PubMedSearch in Google Scholar

William B MorrisonM.D. 

Department of Radiology, Thomas Jefferson University Hospital

111 S. 11th Street, #3390 Gibbon

Philadelphia, PA 19107