Title:X-Ray Versus Magnetic Resonance Imaging in Diabetic Foot Osteomyelitis: A Clinical Comparison
Volume: 17
Issue: 3
Author(s): Karim Gariani*, Dan Lebowitz, Benjamin Kressmann, Joanna Gariani and Ilker Uçkay
Affiliation:
- Division of Endocrinology, Diabetes, Hypertension and Nutrition, Geneva University Hospitals and Faculty of Medicine, Geneva,Switzerland
Keywords:
Diabetic foot osteitis, X-ray, MRI, clinical associations, outcomes, osteomyelitis.
Abstract: 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.