HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: 2233011279v1 223/3/747    most recent Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Ledermann, H. P. Articles by Schweitzer, M. E. Search for Related Content PubMed PubMed Citation Articles by Ledermann, H. P. Articles by Schweitzer, M. E.

MR Image Analysis of Pedal Osteomyelitis: Distribution, Patterns of Spread, and Frequency of Associated Ulceration and Septic Arthritis¹

¹ From the Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pa. Received July 26, 2001; revision requested September 12; revision received October 30; accepted December 10. Address correspondence to H.P.L., Department of Radiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland (e-mail: hans-peter.ledermann@gmx.ch).

PURPOSE: To evaluate the anatomic distribution of pedal osteomyelitis and septic arthritis in a large patient group with advanced pedal infection and to compare ulcer location with the distribution of osteomyelitis and septic arthritis.

MATERIALS AND METHODS: Contrast material–enhanced magnetic resonance (MR) imaging findings were reviewed for 161 feet in 51 women and 107 men (82% of whom had diabetes mellitus) who were suspected of having osteomyelitis and who underwent tissue diagnosis. Location of skin ulceration and presence of osteomyelitis (indicated by means of low T1-weighted signal intensity, high T2-weighted signal intensity, and contrast enhancement) and septic arthritis (indicated by synovial enhancement and adjacent cellulitis) were evaluated by two musculoskeletal radiologists.

RESULTS: In the forefoot, osteomyelitis occurred most frequently at the fifth metatarsal (n = 24), first metatarsal (n = 21), and first distal phalanx (n = 15). In the hindfoot, the calcaneus (n = 21) was involved most frequently. Osteomyelitis was directly adjacent to skin ulcers or surgical defects in all cases but one. Spread of osteomyelitis to adjacent bones in the forefoot occurred in 26 (16%) bones. Evidence of septic arthritis on MR images was present in 53 (33%) feet and involved most frequently the fifth (n = 13) and first (n = 8) metatarsophalangeal joints.

CONCLUSION: Pedal osteomyelitis results almost exclusively from contiguous infections and occurs most frequently around the fifth and first metatarsophalangeal joints. One-third of patients with advanced pedal infection show evidence of septic arthritis on MR images.

© RSNA, 2002

Index terms: Arthritis, septic, 46.26, 46.79 • Bones, infection, 465.211, 466.211, 467.211 • Cellulitis, 468.241 • Foot, infection, 468.21, 468.241 • Foot, MR, 468.121411, 468.121412, 468.121413, 468.121415 • Soft tissues, infection, 468.241

This article has been cited by other articles:

				P. W. Johnson, M. S. Collins, and D. E. Wenger Diagnostic Utility of T1-Weighted MRI Characteristics in Evaluation of Osteomyelitis of the Foot Am. J. Roentgenol., January 1, 2009; 192(1): 96 - 100. [Abstract] [Full Text] [PDF]

				C. C. Roberts, W. B. Morrison, and P. T. Liu Imaging Evaluation of Foot and Ankle Pathology: Self-Assessment Module Am. J. Roentgenol., March 1, 2008; 190(3_Supplement): S18 - S22. [Abstract] [Full Text] [PDF]

				P L Tan and J Teh MRI of the diabetic foot: differentiation of infection from neuropathic change Br. J. Radiol., November 1, 2007; 80(959): 939 - 948. [Abstract] [Full Text] [PDF]

				S Ostlere Imaging the ankle Imaging, September 1, 2007; 19(3): 269 - 298. [Abstract] [Full Text] [PDF]

				M. S. Collins, M. M. Schaar, D. E. Wenger, and J. N. Mandrekar T1-Weighted MRI Characteristics of Pedal Osteomyelitis Am. J. Roentgenol., August 1, 2005; 185(2): 386 - 393. [Abstract] [Full Text] [PDF]

				Z. Keidar, D. Militianu, E. Melamed, R. Bar-Shalom, and O. Israel The Diabetic Foot: Initial Experience with 18F-FDG PET/CT J. Nucl. Med., March 1, 2005; 46(3): 444 - 449. [Abstract] [Full Text] [PDF]

				B. A. Lipsky, A. R. Berendt, H. G. Deery, J. M. Embil, W. S. Joseph, A. W. Karchmer, J. L. LeFrock, D. P. Lew, J. T. Mader, C. Norden, et al. Diagnosis and Treatment of Diabetic Foot Infections J Am Podiatr Med Assoc, March 1, 2005; 95(2): 183 - 210. [Full Text] [PDF]

				M. Karchevsky, M. E. Schweitzer, W. B. Morrison, and J. A. Parellada MRI Findings of Septic Arthritis and Associated Osteomyelitis in Adults Am. J. Roentgenol., January 1, 2004; 182(1): 119 - 122. [Abstract] [Full Text] [PDF]

				S Ostlere Imaging the ankle and foot Imaging, December 1, 2003; 15(4): 242 - 269. [Abstract] [Full Text] [PDF]

				J. L. Bloem, T. J. Mosher, M. R. Schmid, M. Zanetti, H. P. Ledermann, W. B. Morrison, and M. E. Schweitzer Dynamic Gadolinium-enhanced MR Imaging in Bone Marrow Disorders [letter] * Dr Mosher responds: * Drs Schmid and Zanetti respond: * Dr Ledermann and colleagues respond: Radiology, April 1, 2003; 227(1): 303 - 305. [Full Text] [PDF]