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Erschienen in:
22.08.2018 | Scientific Article
Added value of MRI to X-ray in guiding the extent of surgical resection in diabetic forefoot osteomyelitis: a review of pathologically proven, surgically treated cases
Erschienen in: Skeletal Radiology | Ausgabe 3/2019
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Objective
This study retrospectively evaluated the added value of MRI over X-ray in guiding the extent of amputation in a cohort of patients with surgically treated, pathologically proven osteomyelitis.
Materials and methods
A database search revealed 32 cases of pathology-proven diabetic forefoot osteomyelitis between 2006 and 2016, in which X-ray, MRI, and surgery occurred within 30 days. Data collection included extent of osteomyelitis reported on imaging and extent of subsequent amputation using a point system. Added value of MRI over X-ray in guiding surgical resection was stated if the X-ray was negative, MRI was positive, and there was MRI–surgical concordance; if both modalities were positive, X-ray was discordant whereas the MRI was concordant; or if MRI detected an abscess. Two-tailed Fisher’s exact test compared proportions.
Results
In 9 cases that were positive on both modalities, MRI identified an average of 1.2 additional bone segments of disease. There was surgical agreement with X-ray in 3 out of 31 cases (9.7%, 95%CI 0–20.1) and with MRI in 17 out of 31 cases (55%, 37.3–72.4; p < 0.0001). There was an added value of MRI over X-ray in guiding surgical treatment in 64.5% of cases (95% CI 47.7%–81.4%). MRI added value in 5 out of 9 X-rays positive for osteomyelitis and in 15 out of 22 negative (p value was not significant).
Conclusion
Magnetic resonance imaging demonstrated added value over X-ray in guiding surgical management in both X-ray-negative and -positive cases. Although multiple factors are involved in determining the degree of surgical excision, MRI is a clinically useful component of the diagnostic algorithm in patients who undergo surgical treatment.