Skip to main content

Advertisement

SpringerLink
Log in

Role of Dynamic MRI in the follow-up of acute Charcot foot in patients with diabetes mellitus

  • Scientific Article
  • Published:
Skeletal Radiology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the usefulness of magnetic resonance imaging (MRI) in assessing the level of activity of acute Charcot foot, monitoring treatment response and predicting healing time.

Materials and methods

Forty diabetic patients with acute Charcot foot were prospectively enrolled. Patients underwent limb immobilization and were followed every 3 months by clinical examination (skin temperature and circumferences) and MRI. MR protocol included T1-weighted and fast spin echo inversion recovery (FSE-IR) sequences, and a dynamic study (fast spoiled gradient echo), after gadolinium administration (0.1 ml/kg). The contrast medium uptake rate at D-MRI and the signal intensity (SI) ratio on the FSE-IR sequence were measured.

Results

At baseline, mean contrast medium uptake rate was 136±49.7% and the mean SI ratio was 5±3. A high intra- and inter-observer agreement was found for the contrast medium uptake rate, whereas a low agreement was observed for the SI ratio. At 3 months’ follow-up, reduction of the contrast medium uptake rate was observed in all patients with improved clinical findings (n = 34), whereas the SI ratio was reduced in 15/34 (44.1%) patients. Mean healing time was significantly related to the baseline contrast medium uptake rate (P=0.005); it was 5.3 ± 2.7 months in patients with contrast medium uptake rate ≤100%, compared with 9.1 ± 2.5 months in the remaining patients (P=0.0003).

Conclusions

Contrast medium uptake rate obtained at D-MRI represents a reproducible parameter that is reliable for predicting and monitoring treatment outcome in acute Charcot foot.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Edmonds ME. Progress in care of the diabetic foot. Lancet. 1999;354:270–2.

    Article  PubMed  CAS  Google Scholar 

  2. Sella EJ, Barrette C. Staging of Charcot neuroarthropathy along the medial column of the foot in the diabetic patient. J Foot Ankle Surg. 1999;38:34–40.

    Article  PubMed  CAS  Google Scholar 

  3. Sinacore DR, Withrington NC. Recognition and management of acute neuropathic (Charcot) arthropathies of the foot and ankle. J Orthop Sports Phys Ther. 1999;29:736–46.

    PubMed  CAS  Google Scholar 

  4. Baumhauer JF, Wervey R, McWilliams J, Harris GF, Shereff MJ. A comparison study of plantar foot pressure in a standardized shoe, total contact cast, and prefabricated pneumatic walking brace. Foot Ankle Int. 1997;18:26–33.

    PubMed  CAS  Google Scholar 

  5. Rajbhandari SM, Jenkins RC, Davies C, Tesfaye S. Charcot neuroarthropathy in diabetes mellitus. Diabetologia. 2002;45:1085–96.

    Article  PubMed  CAS  Google Scholar 

  6. Mueller MJ, Diamond JE, Sinacore DR, et al. Total contact casting in treatment of diabetic plantar ulcers. Controlled clinical trial. Diabetes Care. 1989;12:384–8.

    Article  PubMed  CAS  Google Scholar 

  7. McGill M, Molyneaux L, Bolton T, Ioannou K, Uren R, Yue DK. Response of Charcot’s arthropathy to contact casting: assessment by quantitative techniques. Diabetologia. 2000;43(4):481–4.

    Article  PubMed  CAS  Google Scholar 

  8. Ulbrecht JS, Wukich DK. The Charcot foot: medical and surgical therapy. Curr Diab Rep. 2008;8:444–51.

    Article  PubMed  Google Scholar 

  9. Nube VL, McGill M, Molyneaux L, Yue DK. From acute to chronic: monitoring the progress of Charcot’s arthropathy. J Am Podiatr Med Assoc. 2002;92:384–9.

    PubMed  Google Scholar 

  10. Gold RH, Tong DJ, Crim JR, Seeger LL. Imaging the diabetic foot. Skeletal Radiol. 1995;24:563–71.

    Article  PubMed  CAS  Google Scholar 

  11. Morrison WB, Ledermann HP. Work-up of the diabetic foot. Radiol Clin North Am. 2002;40:1171–92.

    Article  PubMed  Google Scholar 

  12. Tomas MB, Patel M, Marwin SE, Palestro CJ. The diabetic foot. Br J Radiol. 2000;73:443–50.

    PubMed  CAS  Google Scholar 

  13. Cavanagh PR, Young MJ, Adams JE, Vickers KL, Boulton AJ. Radiographic abnormalities in the feet of patients with diabetic neuropathy. Diabetes Care. 1994;17:201–9.

    Article  PubMed  CAS  Google Scholar 

  14. Boyko EJ, Ahroni JH, Stensel VL. Skin temperature in the neuropathic diabetic foot. J Diabetes Complications. 2001;15:260–4.

    Article  PubMed  CAS  Google Scholar 

  15. Armstrong DG, Lavery LA. Monitoring neuropathic ulcer healing with infrared dermal thermometry. J Foot Ankle Surg. 1996;35:335–8.

    Article  PubMed  CAS  Google Scholar 

  16. Lipman BT, Collier BD, Carrera GF, et al. Detection of osteomyelitis in the neuropathic foot: nuclear medicine, MRI and conventional radiography. Clin Nucl Med. 1998;23:77–82.

    Article  PubMed  CAS  Google Scholar 

  17. Marcus CD, Ladam-Marcus VJ, Leone J, Malgrange D, Bonnet-Gausserand FM, Menanteau BP. MR imaging of osteomyelitis and neuropathic osteoarthropathy in the feet of diabetics. Radiographics. 1996;16:1337–48.

    PubMed  CAS  Google Scholar 

  18. Naftulin KA, Stone PA, McGarry JJ. Osteoarthropathy versus osteomyelitis: does magnetic resonance imaging help? J Am Podiatr Med Assoc. 1996;86:164–9.

    PubMed  CAS  Google Scholar 

  19. Dinh MT, Abad CL, Safdar N. Diagnostic accuracy of the physical examination and imaging tests for osteomyelitis underlying diabetic foot ulcers: meta-analysis. Clin Infect Dis. 2008;47:519–27.

    Article  PubMed  Google Scholar 

  20. Russell JM, Peterson JJ, Bancroft LW. MR imaging of the diabetic foot. Magn Reson Imaging Clin N Am. 2008;16:59–70.

    Article  PubMed  Google Scholar 

  21. Young MJ, Breddy JL, Veves A, Boulton AJ. The prediction of diabetic neuropathic foot ulceration using vibration perception thresholds. A prospective study. Diabetes Care. 1994;17:557–60.

    Article  PubMed  CAS  Google Scholar 

  22. Pinzur MS. Charcot’s foot. Foot Ankle Clin. 2000;5:897–912.

    PubMed  CAS  Google Scholar 

  23. Armstrong DG, Todd WF, Lavery LA, Harkless LB, Bushman TR. The natural history of acute Charcot’s arthropathy in a diabetic foot specialty clinic. J Am Podiatr Med Assoc. 1997;87:272–8.

    PubMed  CAS  Google Scholar 

  24. Sinacore DR. Acute Charcot arthropathy in patients with diabetes mellitus: healing times by foot location. J Diabetes Complications. 1998;12:287–93.

    Article  PubMed  CAS  Google Scholar 

  25. Jude EB, Selby PL, Burgess J, et al. Bisphosphonates in the treatment of Charcot neuroarthropathy: a double-blind randomised controlled trial. Diabetologia. 2001;44:2032–7.

    Article  PubMed  CAS  Google Scholar 

  26. Sartoris DJ. Cross-sectional imaging of the diabetic foot. J Foot Ankle Surg. 1994;33:531–45.

    PubMed  CAS  Google Scholar 

  27. Morrison WB, Ledermann HP, Schweitzer ME. MR imaging of the diabetic foot. Magn Reson Imaging Clin N Am. 2001;9:603–13.

    PubMed  CAS  Google Scholar 

  28. Chantelau E, Richter A, Schmidt-Grigoriadis P, Scherbaum WA. The diabetic charcot foot: MRI discloses bone stress injury as trigger mechanism of neuroarthropathy. Exp Clin Endocrinol Diab. 2006;114:118–23.

    Article  CAS  Google Scholar 

  29. Chantelau E, Poll LW. Evaluation of the diabetic charcot foot by MR imaging or plain radiography—an observational study. Exp Clin Endocrinol Diab. 2006;114:428–31.

    Article  CAS  Google Scholar 

  30. Chantelau E. The perils of procrastination: effects of early vs. delayed detection and treatment of incipient Charcot fracture. Diabet Med. 2005;22:1707–12.

    Article  PubMed  CAS  Google Scholar 

  31. Schlossbauer T, Mioc T, Sommerey S, Kessler SB, Reiser MF, Pfeifer KJ. Magnetic resonance imaging in early stage charcot arthropathy: correlation of imaging findings and clinical symptoms. Eur J Med Res. 2008;13:409–14.

    PubMed  CAS  Google Scholar 

  32. Eustace S, Keogh C, Blake M, Ward RJ, Oder PD, Dimasi M. MR imaging of bone oedema: mechanisms and interpretation. Clin Radiol. 2001;56:4–12.

    Article  PubMed  CAS  Google Scholar 

  33. O’Hare A, Shortt C, Napier N, Eustace SJ. Bone marrow edema: patterns and clinical implications. Semin Musculoskelet Radiol. 2006;10:249–57.

    Article  PubMed  Google Scholar 

  34. Starr AM, Wessely MA, Albastaki U, Pierre-Jerome C, Kettner NW. Bone marrow edema: pathophysiology, differential diagnosis, and imaging. Acta Radiol. 2008;49:771–86.

    Article  PubMed  CAS  Google Scholar 

Download references

Conflict of interest

The authors declare that there is no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology, University of Pisa, Via Paradisa 2, 56127, Pisa, Italy

    Virna Zampa, Irene Bargellini, Francesca Turini, Simona Ortori & Carlo Bartolozzi

  2. Department of Endocrinology and Metabolism, Diabetic Foot Section, University of Pisa, Via Paradisa 2, 56127, Pisa, Italy

    Loredana Rizzo & Alberto Piaggesi

Authors
  1. Virna Zampa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Irene Bargellini
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Loredana Rizzo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Francesca Turini
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Simona Ortori
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Alberto Piaggesi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Carlo Bartolozzi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Virna Zampa.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Zampa, V., Bargellini, I., Rizzo, L. et al. Role of Dynamic MRI in the follow-up of acute Charcot foot in patients with diabetes mellitus. Skeletal Radiol 40, 991–999 (2011). https://doi.org/10.1007/s00256-010-1092-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00256-010-1092-0

Keywords

Search

Navigation