A) Indication of MRI in diabetic foot.
1-In presence of skin ulcer to rule out infection.
2-To evaluate severity of Charcot arthropathy.
3-Or to distinguish between Charcot arthropathy and infection.
B) The vast majority of the diabetic foot infection due to spread from skin ulcer, less commonly a foreign body or iatrogenic cause.
C) The most reliable way to diagnose osteomyelitis is to track the ulcer or sinus tract to the underlying bone and evaluate for the presence of marrow edema as evidenced by low signal intensity on T1 W.I. Abnormal decreased signal intensity on T1 W.I.is a more specific indicator of marrow edema than increased signal intensity on T2 W.I. alone.
D) Here T2 W.I. hyper intensity may indicate osteitis or reactive marrow changes rather than osteomyelitis.
E) Diferential diagnosis of red hot swollen foot:
Location is the most important factor in differentiation between Charcot and osteomyelitis.
F: Osteomyelitis can occurs also in tarsal meta-tarsal joints; in this situation we must look carefully for a sinus tract traveling from a more peripheral location.
G) We use contrast study to evaluate formation of abscess of sinus.
Absccess = periphery of location will enhance leaving a low signal intensity center on fat supressed T1 WI post contrast.
Sinus: Tram track sign.
H) For evaluation of response to treatment we can use dynamic contrast enhanced MRI; in case of improvement of the condition of the disease there will be reduction in the rate of contrast uptake. This method proved to be a reliable indicator for evaluation of treatment in acute charcot foot in diabetic patient.
1-In presence of skin ulcer to rule out infection.
2-To evaluate severity of Charcot arthropathy.
3-Or to distinguish between Charcot arthropathy and infection.
B) The vast majority of the diabetic foot infection due to spread from skin ulcer, less commonly a foreign body or iatrogenic cause.
C) The most reliable way to diagnose osteomyelitis is to track the ulcer or sinus tract to the underlying bone and evaluate for the presence of marrow edema as evidenced by low signal intensity on T1 W.I. Abnormal decreased signal intensity on T1 W.I.is a more specific indicator of marrow edema than increased signal intensity on T2 W.I. alone.
D) Here T2 W.I. hyper intensity may indicate osteitis or reactive marrow changes rather than osteomyelitis.
E) Diferential diagnosis of red hot swollen foot:
Location is the most important factor in differentiation between Charcot and osteomyelitis.
F: Osteomyelitis can occurs also in tarsal meta-tarsal joints; in this situation we must look carefully for a sinus tract traveling from a more peripheral location.
G) We use contrast study to evaluate formation of abscess of sinus.
Absccess = periphery of location will enhance leaving a low signal intensity center on fat supressed T1 WI post contrast.
Sinus: Tram track sign.
H) For evaluation of response to treatment we can use dynamic contrast enhanced MRI; in case of improvement of the condition of the disease there will be reduction in the rate of contrast uptake. This method proved to be a reliable indicator for evaluation of treatment in acute charcot foot in diabetic patient.
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