临床问题：对于患有糖尿病足溃疡的患者，检测潜在骨髓炎的最佳方法是什么？

Clinical Inquiry: What's the best test for underlying osteomyelitis in patients with diabetic foot ulcers?

作者信息

Khodaee Morteza, Lombardo Daniel, Montgomery Linda C, Lyon Corey, Montoya Cathy

机构信息

University of Colorado School of Medicine, Denver, CO, USA.

Houston Community College, TX, USA.

出版信息

J Fam Pract. 2015 May;64(5):309-10, 321.

PMID:26009740

Abstract

Magnetic resonance imaging (MRI) has a higher sensitivity and specificity (90% and 79%) than plain radiography (54% and 68%) for diagnosing diabetic foot osteomyelitis. MRI performs somewhat better than any of several common tests--probe to bone (PTB), erythrocyte sedimentation rate (ESR) >70 mm/hr, C-reactive protein (CRP) >14 mg/L, procalcitonin >0.3 ng/mL, and ulcer size >2 cm²--although PTB has the highest specificity of any test and is commonly used together with MRI. No studies have directly compared MRI with a combination of these tests, which may assist in diagnosis.

摘要

在诊断糖尿病足骨髓炎方面，磁共振成像（MRI）的敏感性和特异性（分别为90%和79%）高于普通X线摄影（分别为54%和68%）。MRI的表现略优于几种常见检查——探及骨质（PTB）、红细胞沉降率（ESR）>70mm/小时、C反应蛋白（CRP）>14mg/L、降钙素原>0.3ng/mL以及溃疡面积>2cm²——尽管PTB是所有检查中特异性最高的，且通常与MRI联合使用。尚无研究直接将MRI与这些检查的组合进行比较，而后者可能有助于诊断。