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Advanced Imaging of the Diabetic Foot and Its
Complications
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OSTEOMYELITIS MR imaging precisely demonstrates the location and extent of osteomyelitis. Primary signs of osteomyelitis include: Bone marrow signal change. Increased signal is seen on T2 and STIR sequences, and decreased signal is seen on T1 weighted sequences. T1 signal changes may not always be present, especially in smaller bones where volume averaging may mask the signal change. Cortical bone interruption. This classic conventional radiographic sign may be better demonstrated on MR imaging due to the tomographic nature of the exam. Soft tissue edema surrounding involved bone. Secondary signs of osteomyelitis include: Ulcer and sinus tract formation. The larger and deeper the ulcer, the greater the association with osteomyelitis. Abscess formation. Soft tissue abscess are highly associated with adjacent osteomyelitis. 52-year-old woman with diabetes and plantar ulcer of 1st toe. Sagital, long and short axis STIR images demonstrate osteomyelitis involving the 1st proximal and distal phalanges, adjacent to the ulcer seen on the sagital and short axis planes. The study clearly demonstrates normal bone marrow signal of the 1st metatarsal. (Click on the images to see larger versions)
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