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Il Giornale Italiano di Radiologia Medica 2019 Settembre-Ottobre;6(5):454-63

DOI: 10.23736/S2283-8376.19.00197-9


language: English, Italian

Magnetic resonance evaluation of diabetic foot osteomyelitis

Giuseppe ARGENTO 1, 2 , Giorgia MANFREDONIA 1, 2, Giulia FIORONI 1, 2, Antonio CREMONA 1, 2, Giulia M. BARELLI 1, 2, Andrea LAGHI 1, 2

1 Department of Radiology, Sant’Andrea University Hospital, Rome, Italy; 2 Faculty of Medicine and Psychology, La Sapienza University, Rome, Italy


BACKGROUND: Osteomyelitis represents 15% of slight complications and even 50% of severe ones of diabetic foot disease. In most of the cases, conventional radiograms are not sufficient to define infective bone involvement. Contrast enhanced magnetic resonance (MR) represents a useful tool from diagnosis to follow-up in treated patients, assessing bone infection course in diabetic disease.
METHODS: A contrast enhanced MR was performed in 156 patients with a supposed clinical and laboratory diagnosis of osteomyelitis in diabetic foot. Inclusion criteria were: clinical diagnosis of ulcers in diabetic foot, fever, presence of remodeled and reabsorbed bone morphology in conventional radiograms.
RESULTS: The evaluation of contrast enhancement in MR analysis detected the presence of abscesses and bone seizure, the recognition of inflammatory osteolysis and the presence of fistulae. The study performed with MR has confirmed the presence of osteolysis in 90% of our pool of patients, and detected an inflammatory involvement of muscles, tenosynovitis and the consensual presence of arthritis. A progression of bone and articular consumption or resolution of the inflammatory process after three months was assessed respectively in 40% and 60% of our sample. Furthermore MR is demonstrated to be fundamental in preoperatory surgical planning in patients with a negative outcome after medical treatment.
CONCLUSIONS: Contrast enhanced MR has been confirmed as an essential comprehensive exam in diagnosis and monitoring during medical treatment. It has been revealed to be useful even concerning the surgical planning in non responders patients, compared to other diagnostic imaging techniques.

KEY WORDS: Diabetic foot; Osteomyelitis; Magnetic resonance imaging

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