Advanced MR Imaging Techniques for Differentiation of Neuropathic Arthropathy and Osteomyelitis in the Diabetic Foot

Abstract

This article reviews the physical basis and clinical role of advanced MR imaging techniques for diabetic foot evaluation, emphasizing the imaging features of bone, soft tissue, joints, and the neurovascular bundle that can help in differentiating neuropathic arthropathy from osteomyelitis. Diagnosis and treatment of foot disease in patients with diabetes is a common clinical-radiologic challenge, particularly the differentiation of neuropathic arthropathy from osteomyelitis. Conventional clinical tests and imaging techniques have limited accuracy for evaluation of the diabetic foot. The introduction of morphologic magnetic resonance (MR) imaging in these patients has provided a qualitative leap in diagnosis. The characteristics of soft-tissue and bone marrow edema and their patterns of distribution throughout the foot allow discrimination between both entities. However, in certain scenarios, the application of MR imaging to this problem is limited because of overlapping features between the two and the coexistence of infection and neuropathic changes. Recent technical advances in MR imaging sequences have increased the capability to add functional quantitative information to structural information. Diffusion-weighted imaging is useful to determine the presence and extension of osteomyelitis...