The possibilities of magnetic resonance imaging in the differential diagnosis of diabetic osteoarthropathy and osteomyelitis

Introduction. The problem of differential diagnostics of diabetic osteoarthropathy (DOAP) and osteomyelitis (OM) of the foot bones for patients with diabetes mellitus is still not finally solved, even with the use of MR imaging.

The aim of the study. To find the MR signs that most accurately indicate the development of osteomyelitis (OM) of the foot bones in patients with diabetic osteoarthropathy (DOAP).

Materials and methods. The study included 62 patientswho successfully completed treatment of uncomplicated or complicated DOAP and had the whole set of diagnostic criteria. They were divided into three groups: acute form of DOAP (n=31), DOAP+soft tissue infection (STI) (n=11) and DOAP+OM (n=20). There were identified6 MR-signs, which could become significant independent classifiers for the differential diagnostics of complicated and uncomplicated forms of DOAP. The diagnostic significance of MR symptoms was assessed in several steps with the use of various methods of statistical analysis.

Results. There was revealed that the groups differ among themselves by 4 MR signs: characteristics of bone marrow edema (p=0.003); swelling of the supporting surfaces (p=0.006); restriction of diffusion in the bone marrow (p=0.001); fistulous course (p=0.001). Points were assigned to these MR criteria. According to the total MR score, groups 1 and 3 (p<0.001); 2 and 3 (p=0.001) differed among themselves. With the use of logistic regression and ROC analysis, we determined the significance of the total MR score for the diagnostics of osteomyelitis. Conclusion. The use of the MR-score summation system helped in the diagnosis of OM. The sum of MR scores ≥3 in the developed scoring system allowsto diagnose OM with high sensitivity (94.1%) and specificity (83.3%). >˂0.001); 2 and 3 (p=0.001) differed among themselves. With the use of logistic regression and ROC analysis, we determined the significance of the total MR score for the diagnostics of osteomyelitis.

Conclusion. The use of the MR-score summation system helped in the diagnosis of OM. The sum of MR scores ≥3 in the developed scoring system allowsto diagnose OM with high sensitivity (94.1%) and specificity (83.3%).

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