Department of Radiology, Mayo Clinic-Rochester, Rochester, MN 55902, USA.
Acad Radiol. 2013 Jan;20(1):108-14. doi: 10.1016/j.acra.2012.07.015. Epub 2012 Sep 13.
The objective of our study was to determine if the T1-weighted magnetic resonance imaging (MRI) features associated with diabetic pedal osteomyelitis are present in histopathologically proven cases of non-pedal osteomyelitis.
Seventy-five patients with a histopathologically proven diagnosis of non-pedal osteomyelitis and a preoperative MRI were identified between 2000 and 2007. The MRIs were retrospectively reviewed for signal characterization of T1-weighted images, including the signal intensity compared with skeletal muscle, distribution of abnormal signal intensity, and pattern of abnormal signal intensity. A subsequent chart review was performed to identify potential clinical factors that were more associated with atypical T1 features of osteomyelitis. Fisher's exact test was performed to determine if there was a statistically significant difference in the T1-weighted imaging features of the hematogenous and nonhematogenous mechanisms of infection.
Seventy of 75 cases demonstrated T1-weighted imaging features typical of pedal osteomyelitis with a confluent region of decreased signal intensity, hypointense, or isointense relative to skeletal muscle in a geographic pattern with medullary distribution. Of the 5 cases that did not demonstrate the typical T1 features associated with pedal osteomyelitis, 4 were considered to have a hematologic mechanism of infection given the absence of surgery, skin ulceration, or a penetrating injury.
The majority of cases of non-pedal osteomyelitis in our study demonstrate the typical T1-weighted imaging features previously documented to correlate with the diagnosis of pedal osteomyelitis. The cases in our series that did not demonstrate the typical T1-weighted features were predominantly secondary to a hematologic mechanism of infection.
本研究的目的是确定与糖尿病足骨髓炎相关的 T1 加权磁共振成像（MRI）特征是否存在于经组织病理学证实的非足部骨髓炎病例中。
在 2000 年至 2007 年间，我们确定了 75 例经组织病理学证实为非足部骨髓炎且术前有 MRI 的患者。对 MRI 进行回顾性分析，以评估 T1 加权图像的信号特征，包括与骨骼肌相比的信号强度、异常信号强度的分布以及异常信号强度的模式。随后进行图表回顾，以确定与骨髓炎非典型 T1 特征更相关的潜在临床因素。采用 Fisher 确切检验确定感染的血源性和非血源性机制在 T1 加权成像特征上是否存在统计学显著差异。
75 例中有 70 例显示 T1 加权成像特征典型，表现为骨髓信号弥漫性降低，与骨骼肌相比呈低信号、低信号或等信号，呈区域性分布。在不表现出与糖尿病足骨髓炎相关的典型 T1 特征的 5 例中，4 例被认为具有血液感染机制，因为缺乏手术、皮肤溃疡或穿透性损伤。
我们研究中的大多数非足部骨髓炎病例表现出与足部骨髓炎诊断相关的典型 T1 加权成像特征。在我们的系列中，不表现出典型 T1 加权特征的病例主要是由于血液感染机制。
