[磁共振成像在糖尿病足综合征患者研究中的作用]

[Role of magnetic resonance imaging in the study of patients with diabetic foot syndrome].

作者信息

Zamyshevskaia M A, Zavadovskaia V D, Udodov V D, Zorkal'tsev M A, Grigor'ev E G

出版信息

Vestn Rentgenol Radiol. 2014 Jul-Aug(4):31-7.

Abstract

OBJECTIVE

To give the results of magnetic resonance imaging (MRI) in patients with complicated diabetic foot syndrome (DFS) to rule out or identify osteomyelitis.

MATERIAL AND METHODS

Twenty-seven (14 women and 13 men; mean age 60 ± 12.2 years) with type 1 and 2 diabetes mellitus and suspected osteomyelitis that had developed in the presence of DFS were examined. Ankle joint and foot MRI was carried out in T1-weighted MR image, T2-weighed MRI image, and FSat sequences. The soft tissue, tendoligamentous apparatus, and bones were evaluated. The results of MRI were compared with the data of a clinical follow-up study and surgery, followed by morphological examination. The diagnosis of osteomyelitis was validly established in 7 cases; this disease was absent in 20 patients.

RESULTS

MRI showed the highest sensitivity for bone marrow edema (100%), soft tissue swelling (85.7%), and their concurrence (85.7%) and the highest specificity for an extensive wound defect or fistula attached to the bone (100%) and bone marrow edema concurrent with tenosynovitis (90%). With a sensitivity of 14.3% and a specificity of 10%, MRI was of less informative value in assessing bone destruction. It was characterized by moderate sensitivity and moderate specificity for soft tissue destruction (57.1 and 42.9%, respectively) and tenosynovitis (55 and 50%, respectively).

CONCLUSION

Osteomyelitis MRI demonstrated a polymorphic pattern with different diagnostic efficiency for individual symptoms.

摘要

目的

给出复杂糖尿病足综合征（DFS）患者的磁共振成像（MRI）结果，以排除或识别骨髓炎。

材料与方法

对27例（14名女性和13名男性；平均年龄60±12.2岁）1型和2型糖尿病且在DFS存在时疑似发生骨髓炎的患者进行检查。采用T1加权磁共振图像、T2加权磁共振图像和脂肪饱和（FSat）序列进行踝关节和足部MRI检查。对软组织、肌腱韧带结构和骨骼进行评估。将MRI结果与临床随访研究及手术数据进行比较，随后进行形态学检查。7例患者确诊为骨髓炎；20例患者未患此病。

结果

MRI对骨髓水肿（100%）、软组织肿胀（85.7%）及其同时出现（85.7%）的敏感性最高，对附着于骨骼的广泛伤口缺损或瘘管（100%）以及与腱鞘炎并发的骨髓水肿（90%）的特异性最高。在评估骨质破坏方面，MRI的敏感性为14.3%，特异性为10%，信息价值较低。其对软组织破坏（分别为57.1%和42.9%）和腱鞘炎（分别为55%和50%）的敏感性和特异性为中等。