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.
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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.