Learning objectives
-To describe the findings,
utility and limitations of the different imaging techniques,in the diagnosis and follow-up of the different pathologies associatedwith diabetic foot.
- To describethe role of Nuclear Imaging in the differential diagnosis between osteomyelitis and neuroarthropathy.
Background
Diabetes mellitus is a multi-systemic disease that is associated with significant complications affecting multiple organs being a very common cause of cardiovascular disease,
end-stage renal disease,
and lower extremity non-traumatic amputations.
As the prevalence of diabetes increases,
a number of important complications affecting the muscles,
spine,
and feet are being seen more frequently [1].
Vasculopathy,
neuropathy and an altered immune response are the three major pathological processes that lead to the development of diabetes-related foot complications [2,3,14].
Costs arising from interventions to prevent and treat...
Imaging findings OR Procedure details
1.
Skin and soft-tissues lesions:
Patients with diabetes are particulary suceptible to these type lesions and these can serve as point of entry for infections.
Ulcers tend to occur in the anatomic sites that are subjected to the highest contact pressures: at the plantar aspect of the first metatarsophalangeal joint and fifth metatarsal head and at the tip of the distal phalanx of the great toe.
Hindfoot ulceration is less common than ulceration in the forefoot and predictably occurs at the heel.
Midfoot ulcers are...
Conclusion
MRI is an useful imaging technique for evaluating infection and neuroarthropathy.
SPECT-CT and PET/CT could be an useful complementary test to rule out superimposed infection.
Suspicion of diabetic foot complications requires the completion of imaging protocols for early diagnosis and avoiding complications and unnecessary cost
References
[1] Baker J et al.
Diabetic musculoskeletal complications and their imaging mimics.
RadioGraphics 2012; 32:1959–1974.
[2] Eser Sanverdi S et al.
Current challenges in imaging of the diabetic foot.
Diabetic Foot & Ankle 2012; 3:18754.
[3] Apelqvist J.
Diagnostics and treatment of the diabetic foot.
Endocrine 2012; 41:384–397.
[4] Pectasides M et al.
Diabetes revealed: Multisystem danger.
AJR 2011;196:274-286.
[5] Donovan A et al.
Use of MR imaging in diagnosing diabetes-related pedal osteomyelitis.
Radiographics 2010; 30:723-736.
[6] Fayad L et al.
musculoskeletal infection: Role of...
Personal Information
Jimena Gonzalez Nieto.
3th year resident.
Radiology Department.
Clinico San carlos Hospital.
Madrid- Spain.
[email protected]
Cristina Batz Colvee.3th year resident.
Radiology Department.
Clinico San carlos Hospital.
Madrid- Spain.
[email protected]
Manuel Moreu Gamazo.
4th year resident.
Radiology Department.
Clinico San carlos Hospital.
Madrid- Spain.
[email protected]
Maria Luisa Vega Gonzalez.
Radiologist.Radiology Department.
Clinico San carlos Hospital.
Madrid- Spain.
Maria Jose Moreno.
Radiologist.
Radiology Department.
Clinico San carlos Hospital.
Madrid- Spain.
[email protected]