Purpose
Optimal current management of the acute diabetic Charcot foot requires accurate and timely diagnosis to allow casting for protection of the foot,
prior to the development of radiographically identifiable fractures or collapse.
Diagnosis and monitoring of such pre-radiographic stage Charcot (Eichenholz stage 0)1necessitates the use of MRI or nuclear medicine techniques for early diagnosis and follow up2.
A two degree Celsius rise in skin temperature of the affected foot is used to make a clinical diagnosis of Charcot,
and a fall in temperature is generally...
Methods and Materials
We studied 35 consecutive diabetic patients who presented to a single centre with acute Charcot osteoarthropathy.
All patients were treated with casting therapy and had MRI scans at presentation and at clinical resolution (skin foot temperature reduction of2 degrees) or at 12 months.
A scoring proforma was devised in collaboration with a Diabetologist and two Musculo-skeletal Radiologists.
On each scan,
all foot/ankle bones (see fig.
1 and 2) were reviewed on two planes for the extent of oedema and the presence of fractures.
Each bone...
Results
Bone Marrow Oedema Score
There was a significant inter-observer correlation between BMO scores at presentation (rs=0.936,
p<0.0001) and at follow up (rs=0.822,
p<0.0001)- Fig.
5 and 6 respectively.
The mean BMO scores were similar between observer 1 and 2 at presentation (18.6±7.3 vs 17.9±1.3,
p=0.092) and at follow up (11.7±5.3 vs 11.1±5,
p=0.257).
Fracture Score
There was a significant inter-observer correlation between the fracture scores at presentation (rs=0.817,
p<0.0001) and at follow up (rs=0.730,
p<0.0001)- Fig.
7 and 8 respectively.
However,
the mean fracture scores...
Conclusion
This study evaluates the reliability of a semi-quantitative MRI score to assess bone marrow oedema and fractures in the acute diabetic Charcot foot.
The score has potential as a diagnostic tool to monitor radiological response and outcome.
References
1.
Edmonds ME,
Watkins PJ.
The Charcot joint: understanding its natural history leads to new treatment and prevention.
Abstract.
Diabet Med.
(1984);1:144A.
2.
Chanteleau EA,
Grutzner G.
Is the Eichenholtz classification still valid for the diabetic Charcot foot? Swiss Med Wkly.
(2014) ;144
3.
Zampa V,
Bargellini I,
Rizzo L,
Turini F,
Ortori S,
Piaggesi A,
Bartolozzi C.
Roel of Dynamic MRI in the follow-up of acute Charcot foot in patients with diabetes mellitus.
Skeletal Radiol (2011) 40: 991-999.
4.
Sanders LJ,
Frykberg RG.
Diabetic...
Personal Information
Dr Raymond Ramnarine: Clinical and InterventionalRadiology Fellow,
Kings College Hospital NHS Foundation Trust,
London,
UK.
[email protected].
Dr Amanda Isaac: Consultant Musculoskeletal Radiologist,
Kings College Hospital NHS Foundation Trust,
London,
UK.
Dr Lisa Meacock: Consultant Musculoskeletal Radiologist,
Kings College Hospital NHS Foundation Trust,
London,
UK.
Dr Nina Petrova: Diabetic Research Fellow,
Kings College Hospital NHS Foundation Trust,
London,
UK.
Prof Mike Edmonds: Consultant Diabetologist,
Kings College Hospital NHS Foundation Trust,
London,
UK.
Dr David Elias: Consultant Musculoskeletal Radiologist,
Kings College Hospital NHS Foundation Trust,
London,
UK.