Diagnostic Value of MRI Symptoms in Patients with Diabetic Foot and Osteomyelitis: Clinical Follow-Up Analysis Preferred Presentation Format

44adult patients with diabetes mellitus were included in this study: 28 men and 16 women underwent operative treatment. Patients with clinically proven osteomyelitis were included in the positive group while patients uncomplicated osteoarthropathy were included in the negative group (Table 1).

^aGroup=1 ^bGroup=0

Following MRI findings were analyzed:
• Bone marrow edema: subchondral and diffuse edema counted separately.
• Bone marrow edema in weight bearing zones, including displaced cuboid and talus bones.
• Diffusion restriction in bone marrow.
• Diffusion restriction in soft tissue.
• Visible with MRI skin ulceration and traveling to weight bearing zone fistula.

Analyzed findings were compared to complex clinical data including post-operative histological data.

ROC-analysis were applied to evaluate diagnostic value of the listed symptoms.

Area under curve as the criterion of diagnostic accuracy is decreasing in following sequence: Fistula (AUC=0,760), bone marrow DWI restriction (AUC=0,698), weight bearing bone marrow edema (AUC=0,682), soft tissue fluid collections DWI restriction (AUC=0,661), diffuse bone marrow edema (AUC=0,605), soft tissue edema (AUC=0,563) (Table 2) (Figure 1).

^aDeLongetal., 1988 ^bBinomialexact

The best MRI diagnostic finding was MRI presentation of fistula but AUC of 0,760 demonstrates insufficient diagnostic value, and this finding also can be easily detected without MRI. Therefore, no one MRI finding is recommended to be taken as sole criterion for deciding on the presence of osteomyelitis, complicating the diabetic osteoarthropathy..

None.

No conflict of interest.