Mascio Antonio, Comisi Chiara, Cinelli Virginia, Pitocco Dario, Greco Tommaso, Maccauro Giulio, Perisano Carlo
Department of Orthopedics and Geriatric Sciences, Catholic University of the Sacred Heart, 00136 Rome, Italy.
Department of Orthopedics and Rheumatological Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00136 Rome, Italy.
Diagnostics (Basel). 2025 Mar 19;15(6):767. doi: 10.3390/diagnostics15060767.
Charcot Neuro-Osteoarthropathy (CNO) is a debilitating complication predominantly affecting individuals with diabetes and peripheral neuropathy. Radiological assessment plays a central role in the diagnosis, staging, and management of CNO. While plain radiographs remain the cornerstone of initial imaging, advanced modalities such as Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) have significantly enhanced diagnostic accuracy. Nuclear imaging, including bone scintigraphy, radiolabeled leukocyte scans, and FDG-PET/CT, offers additional diagnostic precision in complex cases, especially when differentiating CNO from infections or evaluating patients with metal implants. This review underscores the importance of a multimodal imaging approach suited to the clinical stage and specific diagnostic challenges of CNO. It highlights the critical need for standardized imaging protocols and integrated diagnostic algorithms that combine radiological, clinical, and laboratory findings. Advances in imaging biomarkers and novel techniques such as diffusion-weighted MRI hold promise for improving early detection and monitoring treatment efficacy. In conclusion, the effective management of CNO in diabetic foot patients requires a multidisciplinary approach that integrates advanced imaging technologies with clinical expertise. Timely and accurate diagnosis not only prevents debilitating complications but also facilitates the development of personalized therapeutic strategies, ultimately improving patient outcomes.
夏科神经骨关节病（CNO）是一种主要影响糖尿病和周围神经病变患者的致残性并发症。放射学评估在CNO的诊断、分期和管理中起着核心作用。虽然X线平片仍然是初始影像学检查的基石，但磁共振成像（MRI）和计算机断层扫描（CT）等先进检查手段显著提高了诊断准确性。核医学成像，包括骨闪烁显像、放射性标记白细胞扫描和氟代脱氧葡萄糖正电子发射断层显像/计算机断层扫描（FDG-PET/CT），在复杂病例中提供了额外的诊断精度，特别是在鉴别CNO与感染或评估有金属植入物的患者时。本综述强调了适合CNO临床分期和特定诊断挑战的多模态成像方法的重要性。它突出了对标准化成像方案和结合放射学、临床及实验室检查结果的综合诊断算法的迫切需求。成像生物标志物和扩散加权MRI等新技术的进展有望改善早期检测和监测治疗效果。总之，糖尿病足患者CNO的有效管理需要多学科方法，将先进的成像技术与临床专业知识相结合。及时准确的诊断不仅可以预防致残性并发症，还能促进个性化治疗策略的制定，最终改善患者预后。
