ABSTRACT
One of the most important roles of magnetic resonance (MR) in imaging of the diabetic
foot is to differentiate between the common and often comorbid pathologies that present
with abnormal bone marrow signal. The primary diagnostic challenges in this setting
are to distinguish osteomyelitis from reactive bone marrow edema, neuroarthropathy
from osteomyelitis, and the sterile from the superinfected neuropathic joint. Whereas
both osteomyelitis and reactive marrow edema share increased T2 signal, osteomyelitis
is confirmed by T1 hypointensity in the bone marrow and reactive edema demonstrates
isolated T2 signal hyperintensity. In distinguishing osteomyelitis from neuroarthropathy,
a localized or contiguously spreading forefoot focus of abnormal bone marrow away
from the subchondral surface and adjacent to a skin ulcer, cellulitis, abscess, or
sinus tract would be indicative of osteomyelitis. A midfoot, subchondral, periarticular,
or polyarticular distribution of findings in the absence of a contiguous focus of
skin disruption would strongly support neuroarthropathy. Parameters that have been
successfully correlated with acute infection superimposed on neuroarthropathy include
diffuse bone marrow signal abnormality, progressive subarticular enhancement, loss
of subchondral cysts, and the presence of the MRI “ghost sign.”
KEYWORDS
Diabetic foot - magnetic resonance imaging - neuroarthropathy - osteomyelitis
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Javier BeltranM.D.
Department of Radiology, Maimonides Medical Center
4802 10th Ave., Brooklyn, NY 11219
Email: Jbeltran46@msn.com
