Osteomyelitis in feet of diabetics: clinical accuracy, surgical utility, and cost-effectiveness of MR imaging.
OBJECTIVE
To evaluate sensitivity, specificity, clinical utility, and cost-effectiveness of magnetic resonance (MR) imaging in the diagnosis of osteomyelitis of the foot in diabetics.


METHODS
MR studies of 62 feet (diabetics [n = 27], nondiabetics [n = 35]) in 59 patients were prospectively evaluated to detect the presence and extent of osteomyelitis. Biopsy (n = 41 feet) and clinical follow-up (n = 62 feet) were used to establish the diagnosis, select treatment, and determine outcome; sensitivity and specificity of MR imaging were calculated. A cost analysis was performed.


RESULTS
Sensitivity and specificity of MR imaging in the diagnosis of osteomyelitis were 82% and 80%, respectively, in diabetics and 89% and 94%, respectively, in nondiabetics. There was no recurrent infection at the surgical margin in 13 feet in which the area of limited resection had been delineated at MR imaging.


CONCLUSIONS
MR imaging shows good sensitivity and specificity for diagnosing osteomyelitis in diabetic feet, and it is competitively priced compared with other imaging modalities. Accurate delineation of extent allows limited surgical resection, making MR imaging clinically useful and cost-effective.
Morrison
W B
WB
Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA.
Schweitzer
M E
ME
Wapner
K L
KL
Hecht
P J
PJ
Gannon
F H
FH
Behm
W R
WR
D016022:Case-Control Studies; D003287:Contrast Media; D003362:Cost-Benefit Analysis; D017719:Diabetic Foot / Q000175:diagnosis* / Q000601:surgery; D004338:Drug Combinations; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000191:economics; D008297:Male; D008536:Meglumine; D008875:Middle Aged; D009942:Organometallic Compounds; D010019:Osteomyelitis / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D004369:Pentetic Acid / Q000031:analogs & derivatives; D011446:Prospective Studies; D012680:Sensitivity and Specificity
D003287:Contrast Media; D004338:Drug Combinations; D009942:Organometallic Compounds; D008536:Meglumine; D004369:Pentetic Acid; D019786:Gadolinium DTPA