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X-Ray Versus Magnetic Resonance Imaging in Diabetic Foot Osteomyelitis: A Clinical Comparison
Karim Gariani1, Dan Lebowitz1, Benjamin Kressmann2
1Division of Endocrinology, Diabetes, Hypertension and Nutrition, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
Objective:
Radiographic imaging is an important diagnostic tool in diabetic foot osteomyelitis (DFO). It is unknown whether DFO cases diagnosed with conventional X-ray versus positive Magnetic Resonance Imaging (MRI) differ regarding epidemiology and treatment outcome. Theoretically, signs of inflammation on MRI without bone lesions might be easier to treat.
Methods:
Our clinical pathway for diabetic foot infections discourages the use of MRI for the diagnosis of DFO. We compared the epidemiology and therapy of non-amputated DFO with positive features on conventional X-ray, MRI, or both. Radiology specialists interpreted the images. The intraoperative aspect of bone during amputation and the results of bone cultures were considered the gold standard for DFO diagnosis.
Results:
We prospectively followed 390 DFO episodes in 186 adult patients for a median of 2.9 years and performed 318 conventional X-rays (median costs 100 Swiss Francs; 100 US$) and 47 (47/390; 12%) MRI scans (median 800 Swiss Francs; 800 US $). Among them, 18 episodes were associated with positive MRI findings but lacked bone lesions on X-ray. After debridement, the median duration of systemic antibiotics was 28 days for MRI-only episodes and 30 days for X-ray-positive cases (Wilcoxonranksum- test; p=0.26). The corresponding median numbers of surgical debridements were 1 and 1; and recurrence was witnessed in 25% and 28%, respectively. In multivariate logistic regression analysis, MRI-only episodes did not alter the remission rate (odds ratio 0.5, 95%CI 0.1-5.2).
Conclusion:
According to our clinical pathway, DFO episodes with positive MRI findings only did not differ epidemiologically from the remaining DFO cases and did not influence the choice of therapy nor remission rate.
Insights
Diabetic foot osteomyelitis (DFO) diagnosed solely by Magnetic Resonance Imaging (MRI) shows similar outcomes to X-ray confirmed cases. This finding supports current clinical pathways for managing DFO, regardless of initial imaging modality.
Area of Science:
- Orthopedics
- Radiology
- Infectious Diseases
Background:
- Diabetic foot osteomyelitis (DFO) diagnosis relies heavily on radiographic imaging.
- The utility of Magnetic Resonance Imaging (MRI) versus conventional X-ray in DFO diagnosis and treatment outcomes remains unclear.
- MRI may detect inflammation without clear bone lesions, potentially impacting treatment strategies.
Purpose of the Study:
- To compare the epidemiology and treatment outcomes of DFO diagnosed by conventional X-ray versus positive MRI findings.
- To evaluate if MRI-only DFO cases, theoretically easier to treat, exhibit different characteristics or outcomes.
- To assess the impact of imaging modality on DFO management within a specific clinical pathway.
Main Methods:
- A prospective study of 390 DFO episodes in 186 adult patients.
- Comparison of DFO cases with positive conventional X-ray, MRI, or both, with intraoperative findings and bone cultures as gold standard.
- Analysis of epidemiological data, treatment duration, surgical interventions, and remission rates.
Main Results:
- 18 DFO episodes showed positive MRI findings without X-ray bone lesions.
- No significant difference in antibiotic duration (28 vs. 30 days) or surgical debridements (1 vs. 1) between MRI-only and X-ray positive DFO.
- MRI-only DFO episodes did not significantly alter the remission rate (OR 0.5, 95% CI 0.1-5.2).
Conclusions:
- DFO episodes diagnosed with positive MRI findings only did not differ epidemiologically from other DFO cases.
- The imaging modality (X-ray vs. MRI) did not influence therapy choices or remission rates in this cohort.
- Findings support the current clinical pathway's approach to DFO management, irrespective of initial imaging findings.
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