Diabetic foot MRI: Difference between revisions

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==Overview==
==Overview==
[[Magnetic resonance imaging]] ([[Magnetic resonance imaging|MRI]]) is specific for [[osteomyelitis]] [[diagnosis]]. This imaging modality has 90% [[Sensitivity (tests)|sensitivity]] and 85% [[Specificity (tests)|specificity]] in [[diagnosis]] of [[diabetic foot]] [[ulcers]]. While [[Magnetic resonance imaging|MRI]] is very efficient in [[diagnosis]] of [[diabetic foot]], its usage with [[Contrast medium|contrast materials]] such as gadolinium is not recommended in [[diabetes|diabetic]] [[patients]] with evidences of [[kidney|renal]] [[diseases]]. [[Magnetic resonance angiography]] ([[Magnetic resonance angiography|MRA]]) can be helpful in evaluation of [[Limb (anatomy)|limb]] [[perfusion]]. Nevertheless, it has limited spatial resolution and reports could be influenced by previous [[stents]] or [[Implant (medicine)|implants]].


==MRI==
==MRI==
*[[Magnetic resonance imaging]] ([[Magnetic resonance imaging|MRI]]) is specific for [[osteomyelitis]] [[diagnosis]]. This imaging modality has 90% [[Sensitivity (tests)|sensitivity]] and 85% [[Specificity (tests)|specificity]] in [[diagnosis]] of [[diabetic foot]] [[ulcers]].<ref name="pmid9431370">{{cite journal| author=Lipsky BA| title=Osteomyelitis of the foot in diabetic patients. | journal=Clin Infect Dis | year= 1997 | volume= 25 | issue= 6 | pages= 1318-26 | pmid=9431370 | doi=10.1086/516148 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9431370  }} </ref><ref name="pmid28465790">{{cite journal| author=Giurato L, Meloni M, Izzo V, Uccioli L| title=Osteomyelitis in diabetic foot: A comprehensive overview. | journal=World J Diabetes | year= 2017 | volume= 8 | issue= 4 | pages= 135-142 | pmid=28465790 | doi=10.4239/wjd.v8.i4.135 | pmc=5394733 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28465790  }} </ref>
*[[Magnetic resonance imaging]] ([[Magnetic resonance imaging|MRI]]) is specific for [[osteomyelitis]] [[diagnosis]]. This imaging modality has 90% [[Sensitivity (tests)|sensitivity]] and 85% [[Specificity (tests)|specificity]] in [[diagnosis]] of [[diabetic foot]] [[ulcers]].<ref name="pmid9431370">{{cite journal| author=Lipsky BA| title=Osteomyelitis of the foot in diabetic patients. | journal=Clin Infect Dis | year= 1997 | volume= 25 | issue= 6 | pages= 1318-26 | pmid=9431370 | doi=10.1086/516148 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9431370  }} </ref><ref name="pmid28465790">{{cite journal| author=Giurato L, Meloni M, Izzo V, Uccioli L| title=Osteomyelitis in diabetic foot: A comprehensive overview. | journal=World J Diabetes | year= 2017 | volume= 8 | issue= 4 | pages= 135-142 | pmid=28465790 | doi=10.4239/wjd.v8.i4.135 | pmc=5394733 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28465790  }} </ref>
*Usage of [[Contrast medium|contrast materials]] such as gadolinium is not recommended in [[diabetes|diabetic]] [[patients]] with [[kidney|renal]] problems due to high risk of [[Renal insufficiency|renal failure]].<ref name="PrinceZhang2008">{{cite journal|last1=Prince|first1=Martin R.|last2=Zhang|first2=Honglei|last3=Morris|first3=Michael|last4=MacGregor|first4=Jennifer L.|last5=Grossman|first5=Marc E.|last6=Silberzweig|first6=Jeffrey|last7=DeLapaz|first7=Robert L.|last8=Lee|first8=Henry J.|last9=Magro|first9=Cynthia M.|last10=Valeri|first10=Anthony M.|title=Incidence of Nephrogenic Systemic Fibrosis at Two Large Medical Centers|journal=Radiology|volume=248|issue=3|year=2008|pages=807–816|issn=0033-8419|doi=10.1148/radiol.2483071863}}</ref><ref name="RydahlThomsen2008">{{cite journal|last1=Rydahl|first1=Casper|last2=Thomsen|first2=Henrik S.|last3=Marckmann|first3=Peter|title=High Prevalence of Nephrogenic Systemic Fibrosis in Chronic Renal Failure Patients Exposed to Gadodiamide, a Gadolinium-Containing Magnetic Resonance Contrast Agent|journal=Investigative Radiology|volume=43|issue=2|year=2008|pages=141–144|issn=0020-9996|doi=10.1097/RLI.0b013e31815a3407}}</ref>
*Usage of [[Contrast medium|contrast materials]] such as gadolinium is not recommended in [[diabetes|diabetic]] [[patients]] with [[kidney|renal]] problems due to high risk of [[Renal insufficiency|renal failure]].<ref name="PrinceZhang2008">{{cite journal|last1=Prince|first1=Martin R.|last2=Zhang|first2=Honglei|last3=Morris|first3=Michael|last4=MacGregor|first4=Jennifer L.|last5=Grossman|first5=Marc E.|last6=Silberzweig|first6=Jeffrey|last7=DeLapaz|first7=Robert L.|last8=Lee|first8=Henry J.|last9=Magro|first9=Cynthia M.|last10=Valeri|first10=Anthony M.|title=Incidence of Nephrogenic Systemic Fibrosis at Two Large Medical Centers|journal=Radiology|volume=248|issue=3|year=2008|pages=807–816|issn=0033-8419|doi=10.1148/radiol.2483071863}}</ref><ref name="RydahlThomsen2008">{{cite journal|last1=Rydahl|first1=Casper|last2=Thomsen|first2=Henrik S.|last3=Marckmann|first3=Peter|title=High Prevalence of Nephrogenic Systemic Fibrosis in Chronic Renal Failure Patients Exposed to Gadodiamide, a Gadolinium-Containing Magnetic Resonance Contrast Agent|journal=Investigative Radiology|volume=43|issue=2|year=2008|pages=141–144|issn=0020-9996|doi=10.1097/RLI.0b013e31815a3407}}</ref>
*[[Magnetic resonance imaging]] ([[Magnetic resonance imaging|MRI]]) has better efficacy in differentiating [[Tissue (biology)|soft tissue]] from [[bone]], compared to the [[Computed tomography|CT scan]].<ref name="pmid28465790">{{cite journal| author=Giurato L, Meloni M, Izzo V, Uccioli L| title=Osteomyelitis in diabetic foot: A comprehensive overview. | journal=World J Diabetes | year= 2017 | volume= 8 | issue= 4 | pages= 135-142 | pmid=28465790 | doi=10.4239/wjd.v8.i4.135 | pmc=5394733 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28465790  }} </ref>
*[[Magnetic resonance imaging]] ([[Magnetic resonance imaging|MRI]]) has better efficacy in differentiating [[Tissue (biology)|soft tissue]] from [[bone]], compared to the [[Computed tomography|CT scan]]. [[Tissue (biology)|Soft tissue]] [[edema]] is one of the common findings of [[diabetic foot]] in an [[Magnetic resonance imaging|MRI]].<ref name="pmid28465790">{{cite journal| author=Giurato L, Meloni M, Izzo V, Uccioli L| title=Osteomyelitis in diabetic foot: A comprehensive overview. | journal=World J Diabetes | year= 2017 | volume= 8 | issue= 4 | pages= 135-142 | pmid=28465790 | doi=10.4239/wjd.v8.i4.135 | pmc=5394733 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28465790  }} </ref>
*[[Magnetic resonance angiography]] ([[Magnetic resonance angiography|MRA]]) can be helpful in evaluation of [[Limb (anatomy)|limb]] [[perfusion]]. Nevertheless it has limited spatial resolution and reports could be influenced by previous [[stents]] or [[Implant (medicine)|implants]].<ref name="LepäntaloApelqvist2011">{{cite journal|last1=Lepäntalo|first1=M.|last2=Apelqvist|first2=J.|last3=Setacci|first3=C.|last4=Ricco|first4=J.-B.|last5=de Donato|first5=G.|last6=Becker|first6=F.|last7=Robert-Ebadi|first7=H.|last8=Cao|first8=P.|last9=Eckstein|first9=H.H.|last10=De Rango|first10=P.|last11=Diehm|first11=N.|last12=Schmidli|first12=J.|last13=Teraa|first13=M.|last14=Moll|first14=F.L.|last15=Dick|first15=F.|last16=Davies|first16=A.H.|title=Chapter V: Diabetic Foot|journal=European Journal of Vascular and Endovascular Surgery|volume=42|year=2011|pages=S60–S74|issn=10785884|doi=10.1016/S1078-5884(11)60012-9}}</ref>
*[[Magnetic resonance angiography]] ([[Magnetic resonance angiography|MRA]]) can be helpful in evaluation of [[Limb (anatomy)|limb]] [[perfusion]]. Nevertheless, it has limited spatial resolution and reports could be influenced by previous [[stents]] or [[Implant (medicine)|implants]].<ref name="LepäntaloApelqvist2011">{{cite journal|last1=Lepäntalo|first1=M.|last2=Apelqvist|first2=J.|last3=Setacci|first3=C.|last4=Ricco|first4=J.-B.|last5=de Donato|first5=G.|last6=Becker|first6=F.|last7=Robert-Ebadi|first7=H.|last8=Cao|first8=P.|last9=Eckstein|first9=H.H.|last10=De Rango|first10=P.|last11=Diehm|first11=N.|last12=Schmidli|first12=J.|last13=Teraa|first13=M.|last14=Moll|first14=F.L.|last15=Dick|first15=F.|last16=Davies|first16=A.H.|title=Chapter V: Diabetic Foot|journal=European Journal of Vascular and Endovascular Surgery|volume=42|year=2011|pages=S60–S74|issn=10785884|doi=10.1016/S1078-5884(11)60012-9}}</ref>
*[[Magnetic resonance angiography]] ([[Magnetic resonance angiography|MRA]]) has 94% [[Specificity (tests)|specificity]] and [[Sensitivity (tests)|sensitivity]] for [[peripheral arteries]].<ref name="SchaperAndros2012">{{cite journal|last1=Schaper|first1=N. C.|last2=Andros|first2=G.|last3=Apelqvist|first3=J.|last4=Bakker|first4=K.|last5=Lammer|first5=J.|last6=Lepantalo|first6=M.|last7=Mills|first7=J. L.|last8=Reekers|first8=J.|last9=Shearman|first9=C. P.|last10=Zierler|first10=R. E.|last11=Hinchliffe|first11=R. J.|title=Diagnosis and treatment of peripheral arterial disease in diabetic patients with a foot ulcer. A progress report of the International Working Group on the Diabetic Foot|journal=Diabetes/Metabolism Research and Reviews|volume=28|year=2012|pages=218–224|issn=15207552|doi=10.1002/dmrr.2255}}</ref><ref name="pmid11255390">{{cite journal| author=Koelemay MJ, Lijmer JG, Stoker J, Legemate DA, Bossuyt PM| title=Magnetic resonance angiography for the evaluation of lower extremity arterial disease: a meta-analysis. | journal=JAMA | year= 2001 | volume= 285 | issue= 10 | pages= 1338-45 | pmid=11255390 | doi=10.1001/jama.285.10.1338 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11255390  }} </ref>
*[[Magnetic resonance angiography]] ([[Magnetic resonance angiography|MRA]]) has 94% [[Specificity (tests)|specificity]] and [[Sensitivity (tests)|sensitivity]] for [[peripheral arteries]].<ref name="SchaperAndros2012">{{cite journal|last1=Schaper|first1=N. C.|last2=Andros|first2=G.|last3=Apelqvist|first3=J.|last4=Bakker|first4=K.|last5=Lammer|first5=J.|last6=Lepantalo|first6=M.|last7=Mills|first7=J. L.|last8=Reekers|first8=J.|last9=Shearman|first9=C. P.|last10=Zierler|first10=R. E.|last11=Hinchliffe|first11=R. J.|title=Diagnosis and treatment of peripheral arterial disease in diabetic patients with a foot ulcer. A progress report of the International Working Group on the Diabetic Foot|journal=Diabetes/Metabolism Research and Reviews|volume=28|year=2012|pages=218–224|issn=15207552|doi=10.1002/dmrr.2255}}</ref><ref name="pmid11255390">{{cite journal| author=Koelemay MJ, Lijmer JG, Stoker J, Legemate DA, Bossuyt PM| title=Magnetic resonance angiography for the evaluation of lower extremity arterial disease: a meta-analysis. | journal=JAMA | year= 2001 | volume= 285 | issue= 10 | pages= 1338-45 | pmid=11255390 | doi=10.1001/jama.285.10.1338 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11255390  }} </ref>
*Although [[nephrotoxicity]] is lower in [[Magnetic resonance angiography|contrast-enhanced magnetic resonance angiography]] ([[Magnetic resonance angiography|CE-MRA]]), it is [[Contraindication|relatively contraindicated]] in [[patients]] with [[creatinine]] lower than 30 mL/min.<ref name="ChammasHill2016">{{cite journal|last1=Chammas|first1=N. K.|last2=Hill|first2=R. L. R.|last3=Edmonds|first3=M. E.|title=Increased Mortality in Diabetic Foot Ulcer Patients: The Significance of Ulcer Type|journal=Journal of Diabetes Research|volume=2016|year=2016|pages=1–7|issn=2314-6745|doi=10.1155/2016/2879809}}</ref>
*Although [[nephrotoxicity]] is lower in [[Magnetic resonance angiography|contrast-enhanced magnetic resonance angiography]] ([[Magnetic resonance angiography|CE-MRA]]), it is [[Contraindication|relatively contraindicated]] in [[patients]] with [[creatinine]] lower than 30 mL/min.<ref name="ChammasHill2016">{{cite journal|last1=Chammas|first1=N. K.|last2=Hill|first2=R. L. R.|last3=Edmonds|first3=M. E.|title=Increased Mortality in Diabetic Foot Ulcer Patients: The Significance of Ulcer Type|journal=Journal of Diabetes Research|volume=2016|year=2016|pages=1–7|issn=2314-6745|doi=10.1155/2016/2879809}}</ref>


==Examples of MRI Findings in Diabetic Foot==
===Examples of MRI Findings in Diabetic Foot===
 
[[File:Axial T1 MRI.jpg|thumb|center|Destruction of cuneiform bones is present in this axial T1 modality plus talonavicular subluxation, naviculo-cuniform, cuboido-cuneiform and intercuneiform joints derangement in addition to soft tissue and bone marrow edema.<ref>https://radiopaedia.org/cases/diabetic-foot-5?lang=us</ref>]]


==References==
==References==
{{reflist|2}}
{{reflist|2}}
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Latest revision as of 19:37, 14 September 2021

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Anahita Deylamsalehi, M.D.[2]

Overview

Magnetic resonance imaging (MRI) is specific for osteomyelitis diagnosis. This imaging modality has 90% sensitivity and 85% specificity in diagnosis of diabetic foot ulcers. While MRI is very efficient in diagnosis of diabetic foot, its usage with contrast materials such as gadolinium is not recommended in diabetic patients with evidences of renal diseases. Magnetic resonance angiography (MRA) can be helpful in evaluation of limb perfusion. Nevertheless, it has limited spatial resolution and reports could be influenced by previous stents or implants.

MRI

Examples of MRI Findings in Diabetic Foot

Destruction of cuneiform bones is present in this axial T1 modality plus talonavicular subluxation, naviculo-cuniform, cuboido-cuneiform and intercuneiform joints derangement in addition to soft tissue and bone marrow edema.[9]

References

  1. ↑ Lipsky BA (1997). "Osteomyelitis of the foot in diabetic patients". Clin Infect Dis. 25 (6): 1318–26. doi:10.1086/516148. PMID 9431370.
  2. ↑ 2.0 2.1 Giurato L, Meloni M, Izzo V, Uccioli L (2017). "Osteomyelitis in diabetic foot: A comprehensive overview". World J Diabetes. 8 (4): 135–142. doi:10.4239/wjd.v8.i4.135. PMC 5394733. PMID 28465790.
  3. ↑ Prince, Martin R.; Zhang, Honglei; Morris, Michael; MacGregor, Jennifer L.; Grossman, Marc E.; Silberzweig, Jeffrey; DeLapaz, Robert L.; Lee, Henry J.; Magro, Cynthia M.; Valeri, Anthony M. (2008). "Incidence of Nephrogenic Systemic Fibrosis at Two Large Medical Centers". Radiology. 248 (3): 807–816. doi:10.1148/radiol.2483071863. ISSN 0033-8419.
  4. ↑ Rydahl, Casper; Thomsen, Henrik S.; Marckmann, Peter (2008). "High Prevalence of Nephrogenic Systemic Fibrosis in Chronic Renal Failure Patients Exposed to Gadodiamide, a Gadolinium-Containing Magnetic Resonance Contrast Agent". Investigative Radiology. 43 (2): 141–144. doi:10.1097/RLI.0b013e31815a3407. ISSN 0020-9996.
  5. ↑ Lepäntalo, M.; Apelqvist, J.; Setacci, C.; Ricco, J.-B.; de Donato, G.; Becker, F.; Robert-Ebadi, H.; Cao, P.; Eckstein, H.H.; De Rango, P.; Diehm, N.; Schmidli, J.; Teraa, M.; Moll, F.L.; Dick, F.; Davies, A.H. (2011). "Chapter V: Diabetic Foot". European Journal of Vascular and Endovascular Surgery. 42: S60–S74. doi:10.1016/S1078-5884(11)60012-9. ISSN 1078-5884.
  6. ↑ Schaper, N. C.; Andros, G.; Apelqvist, J.; Bakker, K.; Lammer, J.; Lepantalo, M.; Mills, J. L.; Reekers, J.; Shearman, C. P.; Zierler, R. E.; Hinchliffe, R. J. (2012). "Diagnosis and treatment of peripheral arterial disease in diabetic patients with a foot ulcer. A progress report of the International Working Group on the Diabetic Foot". Diabetes/Metabolism Research and Reviews. 28: 218–224. doi:10.1002/dmrr.2255. ISSN 1520-7552.
  7. ↑ Koelemay MJ, Lijmer JG, Stoker J, Legemate DA, Bossuyt PM (2001). "Magnetic resonance angiography for the evaluation of lower extremity arterial disease: a meta-analysis". JAMA. 285 (10): 1338–45. doi:10.1001/jama.285.10.1338. PMID 11255390.
  8. ↑ Chammas, N. K.; Hill, R. L. R.; Edmonds, M. E. (2016). "Increased Mortality in Diabetic Foot Ulcer Patients: The Significance of Ulcer Type". Journal of Diabetes Research. 2016: 1–7. doi:10.1155/2016/2879809. ISSN 2314-6745.
  9. ↑ https://radiopaedia.org/cases/diabetic-foot-5?lang=us
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