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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

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Abstract

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.

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Authors and Affiliations

  1. Albert Einstein Medical Center, Philadelphia, PA, USA

    Micah Cohen, Brett Cerniglia & Tetyana Gorbachova

  2. Drexel College School of Medicine, Philadelphia, PA, USA

    Jay Horrow

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  1. Micah Cohen
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  2. Brett Cerniglia
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  3. Tetyana Gorbachova
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Correspondence to Micah Cohen.

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Cohen, M., Cerniglia, B., Gorbachova, T. et al. 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. Skeletal Radiol 48, 405–411 (2019). https://doi.org/10.1007/s00256-018-3045-y

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  • DOI: https://doi.org/10.1007/s00256-018-3045-y

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