THE ROLE OF SERIAL RADIOGRAPHS TO DIAGNOSE DIABETIC FOOT BONE INFECTION. Serial radiographs and diabetic foot osteomyelitis
Main Article Content
Keywords
Diabetic foot, Osteomyelitis, Radiography, Magnetic resonance imaging
Abstract
Purpose: To evaluate the role of progressive radiographic changes to diagnose diabetic foot osteomyelitis.
Materials and Methods: A retrospective review of databases of our Institution was performed to identify all long-standing diabetic foot patients who underwent two radiographic examinations spaced no more than five weeks apart and a subsequent magnetic resonance (MR) examination from November 2015 to November 2020. A total of 46 patients (32 men, 14 women; mean age, 57.3 years) were identified.
Results: serial radiographs showed 89% sensitivity, 38% specificity, 80% diagnostic accuracy, 87% positive predictive value (PPV), 43% negative predictive value (NPV) to diagnose osteomyelitis (P value < 0,05). Bone destruction was the most reliable radiographic sign with 89% sensitivity, 88% specificity, 89% diagnostic accuracy, 97% PPV, 64% NPV (P value < 0,05).
Conclusion: Progressive bony changes detected by serial radiographs are a useful tool to diagnose diabetic foot osteomyelitis.
Downloads
Abstract 690
PDF Downloads 441
HTML Downloads 168
References
2) Lauri C, Leone A, Cavallini M, Signore A, Giurato L, Uccioli L. Diabetic Foot Infections: The Diagnostic Challenges. J Clin Med. 2020 Jun 8;9(6):1779.
3) Leone A, Vitiello C, Gullì C, Sikora AK, Macagnino S, Colosimo C. Bone and soft tissue infections in patients with diabetic foot. Radiol Med. 2020;125(2):177-187.
4) Senneville EM, Lipsky BA, van Asten SAV, Peters EJ. Diagnosing diabetic foot osteomyelitis. Diabetes Metab Res Rev. 2020 Mar;36 Suppl 1:e3250.
5) Markanday A. Diagnosing diabetic foot osteomyelitis: narrative review and a suggested 2-step score-based diagnostic pathway for clinicians. Open Forum Infect Dis. 2014 Aug 7;1(2):ofu060.
6) Konarzewska A, Korzon-Burakowska A, Rzepecka-Wejs L, Sudoł-Szopińska I, Szurowska E, Studniarek M. Diabetic foot syndrome: Charcot arthropathy or osteomyelitis? Part I: Clinical picture and radiography. J Ultrason. 2018 Mar;18(72):42-49. doi: 10.15557/JoU.2018.0007.
7) Aragón-Sánchez J. Seminar review: A review of the basis of surgical treatment of diabetic foot infections. Int J Low Extrem Wounds. 2011 Mar;10(1):33-65.
8) Nawaz A, Torigian DA, Siegelman ES, Basu S, Chryssikos T, Alavi A. Diagnostic performance of FDG-PET, MRI, and plain film radiography (PFR) for the diagnosis of osteomyelitis in the diabetic foot. Mol Imaging Biol. 2010 Jun;12(3):335-42.
9) Linsley, J., & Reel, S. (2021). The appropriateness of X-ray referrals of osteomylelitis and its timely management with antibiotics: a service evaluation. The Diabetic Foot Journal, 24(3), 10-15
10) Lee YJ, Sadigh S, Mankad K, Kapse N, Rajeswaran G. The imaging of osteomyelitis. Quant Imaging Med Surg. 2016 Apr;6(2):184-98.
11) Lipsky BA. Osteomyelitis of the foot in diabetic patients. Clin Infect Dis. 1997 Dec;25(6):1318-26.
12) Vopat ML, Nentwig MJ, Chong ACM, Agan JL, Shields NN, Yang SY. Initial Diagnosis and Management for Acute Charcot Neuroarthropathy. Kans J Med. 2018 Nov 29;11(4):114-119.
13) Dinh MT, Abad CL, Safdar N. Diagnostic accuracy of the physical examination and imaging tests for osteomyelitis underlying diabetic foot ulcers: meta-analysis. Clin Infect Dis. 2008 Aug 15;47(4):519-27.
14) Schinabeck MK, Johnson JL. Osteomyelitis in diabetic foot ulcers. Prompt diagnosis can avert amputation. Postgrad Med. 2005 Jul;118(1):11-5.
15) Lipsky BA, Berendt AR, Cornia PB et al.; Infectious Diseases Society of America. 2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections. Clin Infect Dis. 2012 Jun;54(12):e132-73.
16) Tran K, Mierzwinski-Urban M. Serial X-Ray Radiography for the Diagnosis of Osteomyelitis: A Review of Diagnostic Accuracy, Clinical Utility, Cost-Effectiveness, and Guidelines [Internet]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2020 Mar 13.
17) Donovan A, Schweitzer ME. Use of MR imaging in diagnosing diabetes-related pedal osteomyelitis. Radiographics. 2010 May;30(3):723-36.
18) Hochman M.G., Connolly C. (2018) Imaging of Infection in the Diabetic Foot. In: Veves A., Giurini J., Guzman R. (eds) The Diabetic Foot. Contemporary Diabetes. Humana, Cham.
19) Internal Clinical Guidelines team. Diabetic Foot Problems: Prevention and Management. London: National Institute for Health and Care Excellence (UK); 2015 Aug.
20) Llewellyn A, Kraft J, Holton C, Harden M, Simmonds M. Imaging for detection of osteomyelitis in people with diabetic foot ulcers: A systematic review and meta-analysis. Eur J Radiol. 2020 Oct;131:109215.
21) Crim JR, Seeger LL. Imaging evaluation of osteomyelitis. Crit Rev Diagn Imaging. 1994;35(3):201-56.
22) Lipsky BA, Senneville É, Abbas ZG et al; International Working Group on the Diabetic Foot (IWGDF). Guidelines on the diagnosis and treatment of foot infection in persons with diabetes (IWGDF 2019 update). Diabetes Metab Res Rev. 2020 Mar;36 Suppl 1:e3280
23) Álvaro-Afonso FJ, Lázaro-Martínez JL, García-Morales E, García-Álvarez Y, Sanz-Corbalán I, Molines-Barroso RJ. Cortical disruption is the most reliable and accurate plain radiographic sign in the diagnosis of diabetic foot osteomyelitis. Diabet Med. 2019 Feb;36(2):258-259.
Article Sidebar
Article Details
How to Cite
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Transfer of Copyright and Permission to Reproduce Parts of Published Papers. Authors will grant copyright of their articles to the Institute of Hematology, Catholic University, Rome . No formal permission will be required to reproduce parts (tables or illustrations) of published papers, provided the source is quoted appropriately and reproduction has no commercial intent. Reproductions with commercial intent will require written permission and payment of royalties.
Nicola Carlo BIANCO, Catholic University Rome
Department of Radiological and Hematological Sciences, Catholic University, Rome. Resident in Radiology
Giulia D'AMBRA, Catholic University Rome
Department of Radiological and Hematological Sciences, Catholic University, Rome. Resident in Radiology
Salvatore LUCCHESI, Catholic University Rome
Department of Radiological anf Hematological Sciences, Catholic University, Rome. Resident in Radiology
Elisa LA ROSA, Catholic University Rome
Department of Radiological anf Hematological Sciences, Catholic University, Rome. Resident in Radiology
Amato INFANTE, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Rome
Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Rome Medical assistant.
Daniele PERLA, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Rome
Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Rome. Medical assistant.
Consolato GULLI', Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome
Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome. Medical assistant.