X-ray versus magnetic resonance imaging in diabetic foot osteomyelitis: a clinical comparison.
Open accessAbstract
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.
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Most wound classification systems focus on the degree of tissue loss, with less emphasis on concomitant infection or ischemia.
“Although there are numerous wound classification systems, most focus on the degree of tissue loss, with less emphasis on concomitant infection or ischemia.36,37”
From Diabetic Foot Ulcers (2023) · cites this paper as [37]
The Methods and General results and treatment sections discuss imaging criteria and characteristics of diabetic foot osteomyelitis, not wound classification systems. Searches for tissue loss, infection, ischemia, and wound-grading systems found no passage comparing what those systems emphasize. Page numbers were not available in our copy. (LLM, conf=0.76)
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Armstrong, D. G., Tan, T.-W., Boulton, A. J. M., & Bus, S. A. (2023) · JAMA · doi:10.1001/jama.2023.10578 · Cited by 1,658 · see citing works
- Authors
- Gariani, K., Lebowitz, D., Kressmann, B., Gariani, J., & Uçkay, I.
- Affiliations
- University of Geneva (CH)
- University Hospital of Geneva (CH)
- Clinical Pathway of Diabetic Foot Infections, University of Geneva Hospitals and Medical School, 1211 Geneva,Switzerland
- Corresponding author
- Gariani, Karim
- Venue
- Current Diabetes Reviews
- Publisher
- Bentham Science Publishers Ltd.
- Published
- 2021-03
- Volume
- 17
- Issue
- 3
- Pages
- 373-377
- ISSN
- 1573-3998 (ISSN-L)
- OpenAlex
- W3046862545
- Cited by
- 9
- References
- 16
- Citations by year
- 2025: 2 · 2023: 3 · 2022: 2 · 2021: 2
- FWCI
- 1.32
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Current Diabetes Reviews (publishedVersion)
- PubMed (publishedVersion)
- Zurich Open Repository and Archive (University of Zurich) (acceptedVersion, cc-by)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion, cc-by)
- Zurich Open Repository and Archive (University of Zurich)
- Funders
- Hôpitaux Universitaires de Genève
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetic Foot Ulcer Assessment and Management
- Health Sciences › Medicine › Surgery › Orthopedic Infections and Treatments
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Foot and Ankle Surgery
- Keywords
- diabetic foot osteomyelitis, magnetic resonance imaging, conventional X-ray, diagnostic imaging comparison, bone lesions, bone culture, amputation, surgical debridement, antibiotic duration, recurrence, remission, imaging costs
- MeSH terms
- Adult, Amputation, Surgical, Diabetes Mellitus, Humans, Magnetic Resonance Imaging, Osteomyelitis, X-Rays, Diabetic Foot
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