Neuropathic arthropathy of the foot with and without superimposed osteomyelitis

MR imaging characteristics

Mazyar E. Ahmadi, William B. Morrison, John A. Carrino, Mark E. Schweitzer, Steven M. Raikin, Hans P. Ledermann

Research output: Contribution to journalArticle

Abstract

Purpose: To determined retrospectively the magnetic resonance (MR) findings associated with pedal neuropathic arthropathy with and without superimposed osteomyelitis and to identify any useful discriminating features. Materials and Methods: Investigational review board approval was obtained and allowed review of records and images without informed consent. HIPAA compliance was observed. Contrast-enhanced MR images in patients with diabetic neuropathic arthropathy of the foot were examined by two reviewers in consensus. Affected joints were examined for marrow, articular, periarticular, and soft-tissue findings. Presence of superimposed osteomyelitis was documented. A subgroup that had undergone MR before infection was evaluated for comparison; χ2 and t tests were used to evaluate the associations. Results: Of 128 neuropathic joints in 63 patients (24 female, 39 male; aged 31-78 years), 43 had superimposed osteomyelitis. Effusion was common in all neuropathic joints, but thin rim enhancement was more common in noninfected joints (62% vs 21%, P <.001) and diffuse joint fluid enhancement was more common with infection (47% vs 26%, P = .052). Subluxation, bone proliferation, fragmentation, and erosion were seen in both groups, but intraarticular bodies were more common in noinfected joints (53% vs 12%, P <.001). In the periarticular soft tissues, edema, enhancement, and ulceration were common in both groups. Fluid collections in the soft tissues were more commonly associated with infected joints (95% vs 48%, P <.001) and, when present next to an infected joint, were larger than those next to noninfected neuropathic joints (2.6 cm2 [range, 0.3-8.6 cm2] vs 1.6 cm2 [range, 1.0-2.4 cm2]). Soft-tissue fat replacement (68% vs 36%, P = .002) and sinus tracts (84% vs 0%, P <.001) were also more common with infection. In the marrow, periarticular signal intensity abnormality was common in both groups, but the extent was greater with infection. Subchondral cysts were seen almost exclusively in noninfected joints (76% vs 2%, P <.001). Similar results were obtained in the subgroup of 21 joints (15 patients) with both pre- and postinfection MR images. Conclusion: Sinus tract, replacement of soft-tissue fat, fluid collection, and extensive marrow abnormality are MR imaging features indicating superimposed infection. Thin rim enhancement of effusion, presence of subchondral cysts, or intraarticular bodies indicate absence of infection.

Original languageEnglish (US)
Pages (from-to)622-631
Number of pages10
JournalRadiology
Volume238
Issue number2
DOIs
StatePublished - Feb 2006
Externally publishedYes

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Joint Diseases
Osteomyelitis
Foot
Joints
Magnetic Resonance Imaging
Magnetic Resonance Spectroscopy
Infection
Bone Cysts
Bone Marrow
Fats
Health Insurance Portability and Accountability Act
Informed Consent
Compliance
Edema

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology

Cite this

Ahmadi, M. E., Morrison, W. B., Carrino, J. A., Schweitzer, M. E., Raikin, S. M., & Ledermann, H. P. (2006). Neuropathic arthropathy of the foot with and without superimposed osteomyelitis: MR imaging characteristics. Radiology, 238(2), 622-631. https://doi.org/10.1148/radiol.2382041393

Neuropathic arthropathy of the foot with and without superimposed osteomyelitis : MR imaging characteristics. / Ahmadi, Mazyar E.; Morrison, William B.; Carrino, John A.; Schweitzer, Mark E.; Raikin, Steven M.; Ledermann, Hans P.

In: Radiology, Vol. 238, No. 2, 02.2006, p. 622-631.

Research output: Contribution to journalArticle

Ahmadi, ME, Morrison, WB, Carrino, JA, Schweitzer, ME, Raikin, SM & Ledermann, HP 2006, 'Neuropathic arthropathy of the foot with and without superimposed osteomyelitis: MR imaging characteristics', Radiology, vol. 238, no. 2, pp. 622-631. https://doi.org/10.1148/radiol.2382041393
Ahmadi ME, Morrison WB, Carrino JA, Schweitzer ME, Raikin SM, Ledermann HP. Neuropathic arthropathy of the foot with and without superimposed osteomyelitis: MR imaging characteristics. Radiology. 2006 Feb;238(2):622-631. https://doi.org/10.1148/radiol.2382041393
Ahmadi, Mazyar E. ; Morrison, William B. ; Carrino, John A. ; Schweitzer, Mark E. ; Raikin, Steven M. ; Ledermann, Hans P. / Neuropathic arthropathy of the foot with and without superimposed osteomyelitis : MR imaging characteristics. In: Radiology. 2006 ; Vol. 238, No. 2. pp. 622-631.
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abstract = "Purpose: To determined retrospectively the magnetic resonance (MR) findings associated with pedal neuropathic arthropathy with and without superimposed osteomyelitis and to identify any useful discriminating features. Materials and Methods: Investigational review board approval was obtained and allowed review of records and images without informed consent. HIPAA compliance was observed. Contrast-enhanced MR images in patients with diabetic neuropathic arthropathy of the foot were examined by two reviewers in consensus. Affected joints were examined for marrow, articular, periarticular, and soft-tissue findings. Presence of superimposed osteomyelitis was documented. A subgroup that had undergone MR before infection was evaluated for comparison; χ2 and t tests were used to evaluate the associations. Results: Of 128 neuropathic joints in 63 patients (24 female, 39 male; aged 31-78 years), 43 had superimposed osteomyelitis. Effusion was common in all neuropathic joints, but thin rim enhancement was more common in noninfected joints (62{\%} vs 21{\%}, P <.001) and diffuse joint fluid enhancement was more common with infection (47{\%} vs 26{\%}, P = .052). Subluxation, bone proliferation, fragmentation, and erosion were seen in both groups, but intraarticular bodies were more common in noinfected joints (53{\%} vs 12{\%}, P <.001). In the periarticular soft tissues, edema, enhancement, and ulceration were common in both groups. Fluid collections in the soft tissues were more commonly associated with infected joints (95{\%} vs 48{\%}, P <.001) and, when present next to an infected joint, were larger than those next to noninfected neuropathic joints (2.6 cm2 [range, 0.3-8.6 cm2] vs 1.6 cm2 [range, 1.0-2.4 cm2]). Soft-tissue fat replacement (68{\%} vs 36{\%}, P = .002) and sinus tracts (84{\%} vs 0{\%}, P <.001) were also more common with infection. In the marrow, periarticular signal intensity abnormality was common in both groups, but the extent was greater with infection. Subchondral cysts were seen almost exclusively in noninfected joints (76{\%} vs 2{\%}, P <.001). Similar results were obtained in the subgroup of 21 joints (15 patients) with both pre- and postinfection MR images. Conclusion: Sinus tract, replacement of soft-tissue fat, fluid collection, and extensive marrow abnormality are MR imaging features indicating superimposed infection. Thin rim enhancement of effusion, presence of subchondral cysts, or intraarticular bodies indicate absence of infection.",
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AU - Morrison, William B.

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AU - Schweitzer, Mark E.

AU - Raikin, Steven M.

AU - Ledermann, Hans P.

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N2 - Purpose: To determined retrospectively the magnetic resonance (MR) findings associated with pedal neuropathic arthropathy with and without superimposed osteomyelitis and to identify any useful discriminating features. Materials and Methods: Investigational review board approval was obtained and allowed review of records and images without informed consent. HIPAA compliance was observed. Contrast-enhanced MR images in patients with diabetic neuropathic arthropathy of the foot were examined by two reviewers in consensus. Affected joints were examined for marrow, articular, periarticular, and soft-tissue findings. Presence of superimposed osteomyelitis was documented. A subgroup that had undergone MR before infection was evaluated for comparison; χ2 and t tests were used to evaluate the associations. Results: Of 128 neuropathic joints in 63 patients (24 female, 39 male; aged 31-78 years), 43 had superimposed osteomyelitis. Effusion was common in all neuropathic joints, but thin rim enhancement was more common in noninfected joints (62% vs 21%, P <.001) and diffuse joint fluid enhancement was more common with infection (47% vs 26%, P = .052). Subluxation, bone proliferation, fragmentation, and erosion were seen in both groups, but intraarticular bodies were more common in noinfected joints (53% vs 12%, P <.001). In the periarticular soft tissues, edema, enhancement, and ulceration were common in both groups. Fluid collections in the soft tissues were more commonly associated with infected joints (95% vs 48%, P <.001) and, when present next to an infected joint, were larger than those next to noninfected neuropathic joints (2.6 cm2 [range, 0.3-8.6 cm2] vs 1.6 cm2 [range, 1.0-2.4 cm2]). Soft-tissue fat replacement (68% vs 36%, P = .002) and sinus tracts (84% vs 0%, P <.001) were also more common with infection. In the marrow, periarticular signal intensity abnormality was common in both groups, but the extent was greater with infection. Subchondral cysts were seen almost exclusively in noninfected joints (76% vs 2%, P <.001). Similar results were obtained in the subgroup of 21 joints (15 patients) with both pre- and postinfection MR images. Conclusion: Sinus tract, replacement of soft-tissue fat, fluid collection, and extensive marrow abnormality are MR imaging features indicating superimposed infection. Thin rim enhancement of effusion, presence of subchondral cysts, or intraarticular bodies indicate absence of infection.

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