MR Imaging of Diabetic Foot Infection

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
• 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
• 3 Jeffcoate W, Lima J, Nobrega L. The Charcot foot.  Diabet Med. 2000;  17 253-258
• 4 Johnson J T. Neuropathic fractures and joint injuries. Pathogenesis and rationale of prevention and treatment.  J Bone Joint Surg. 1967;  49 1-30
• 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
• 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
• 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
• 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
• 9 Most R S, Sinnock P. The epidemiology of lower extremity amputations in diabetic individuals.  Diabetes Care. 1983;  6 87-91
• 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
• 11 Goldner M G. The fate of the second leg in the diabetic amputee.  Diabetes. 1960;  9 100-103
• 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
• 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
• 14 Dangman B C, Hoffer F A, Rand F F et al.. Osteomyelitis in children: gadolinium-enhanced MR imaging.  Radiology. 1992;  182 743-747
• 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
• 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
• 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
• 18 Levin M E. Foot lesions in patients with diabetes mellitus.  Endocrinol Metab Clin North Am. 1996;  25 447-462
• 19 Sumpio B E. Foot ulcers.  N Engl J Med. 2000;  343 787-793
• 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
• 21 Stadelmann W K, Digenis A G, Tobin G R. Impediments to wound healing.  Am J Surg. 1998;  176 39S-47S
• 22 Lipsky B A. Osteomyelitis of the foot in diabetic patients.  Clin Infect Dis. 1997;  25 1318-1326
• 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
• 24 Unger E, Moldofsky P, Gatenby R et al.. Diagnosis of osteomyelitis by MR imaging.  AJR. 1988;  150 605-610
• 25 Beltran J, Campanini D S, Knight C et al.. The diabetic foot: magnetic resonance imaging evaluation.  Skeletal Radiol. 1990;  19 37-41
• 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
• 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
• 28 Paajanen H, Grodd W, Revel D et al.. Gadolinium-DTPA enhanced MR imaging of intramuscular abscesses.  Magn Reson Imaging. 1987;  5 109-115
• 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
• 30 Jaovisidha S, Chen C, Ryu K N et al.. Tuberculous tenosynovitis and bursitis: imaging findings in 21 cases.  Radiology. 1996;  201 507-513
• 31 Brower A C. Septic arthritis.  Radiol Clin North Am. 1996;  34 293-309
• 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
• 33 Graif M, Schweitzer M E, Deely D et al.. The septic versus nonseptic inflamed joint: MRI characteristics.  Skeletal Radiol. 1999;  28 616-620
• 34 Capitanio M A, Kirkpatrick J A. Early roentgen observations in acute osteomyelitis.  Am J Roentgenol Radium Ther Nucl Med. 1970;  108 488-496
• 35 David R, Barron B J, Madewell J E. Osteomyelitis, acute and chronic.  Radiol Clin North Am. 1987;  25 1171-1201
• 36 Schauwecker D S, Braunstein E M, Wheat L J. Diagnostic imaging of osteomyelitis.  Infect Dis Clin North Am. 1990;  4 441-463
• 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
• 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
• 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
• 40 Schon L C, Easley M E, Weinfeld S B. Charcot neuroarthropathy of the foot and ankle.  Clin Orthop. 1998;  349 116-131
• 41 Crim J R, Seeger L L. Imaging evaluation of osteomyelitis.  Crit Rev Diagn Imaging. 1994;  35 201-256
• 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
• 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
• 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
• 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
• 46 Gold R H, Tong D J, Crim J R et al.. Imaging the diabetic foot.  Skeletal Radiol. 1995;  24 563-571
• 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
• 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
• 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
• 50 Yu J S. Diabetic foot and neuroarthropathy: magnetic resonance imaging evaluation.  Top Magn Reson Imaging. 1998;  9 295-310
• 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
• 52 Nguyen V D. The radiologic spectrum of abnormalities of the foot in diabetic patients.  Can Assoc Radiol J. 1992;  43 333-339