CT Foot CT is able to image large anatomic regions rapidly with multiplanar capability. CT with or without IV contrast demonstrates the features of acute osteomyelitis, such as periosteal reaction, endosteal scalloping, and lytic bone destruction, more clearly and in more detail than on radiographs, but is less sensitive than MRI and nuclear medicine studies for detecting early intramedullary changes of acute osteomyelitis [15]. Features of chronic osteomyelitis (sequestra, involucrum, cloaca, sinus tracts) are well depicted on CT with or without IV contrast. CT with or without IV contrast may be superior to MRI for the findings of sequestra, foreign bodies, and soft- tissue gas [16]. CT with or without IV contrast is more sensitive than radiographs to osseous changes, allowing Suspected Osteomyelitis of the Foot earlier detection of neuropathic arthropathy changes of debris, fragmentation, disruption, and dislocation [3,17]. When metal is present in or near the area of interest, there is significant loss of image resolution that is due to a beam-hardening artifact [13]. Dual-energy CT may be useful for metal artifact reduction if available. With high- resolution multiplanar imaging, CT is able to delineate the anatomic extent of soft-tissue infections. Contrast is preferred for the evaluation of soft-tissue infection and delineation of fluid collections [16]. MRI Foot MRI with or without enhancement is the favored modality in this variant and has demonstrated high sensitivity (90%) and specificity (83%) for early osteomyelitis in a large meta-analysis [23]. MRI with or without enhancement demonstrates excellent soft-tissue contrast and sensitivity to marrow abnormalities [18,19] with high-resolution detail in multiple anatomic planes. Normal marrow signal reliably excludes osteomyelitis [20]. Positive cases of osteomyelitis demonstrate decreased T1-weighted bone marrow signal and increased signal on fluid-sensitive sequences [21,22].
Suspected Osteomyelitis of the Foot in Patients with Diabetes Mellitus. CT Foot CT is able to image large anatomic regions rapidly with multiplanar capability. CT with or without IV contrast demonstrates the features of acute osteomyelitis, such as periosteal reaction, endosteal scalloping, and lytic bone destruction, more clearly and in more detail than on radiographs, but is less sensitive than MRI and nuclear medicine studies for detecting early intramedullary changes of acute osteomyelitis [15]. Features of chronic osteomyelitis (sequestra, involucrum, cloaca, sinus tracts) are well depicted on CT with or without IV contrast. CT with or without IV contrast may be superior to MRI for the findings of sequestra, foreign bodies, and soft- tissue gas [16]. CT with or without IV contrast is more sensitive than radiographs to osseous changes, allowing Suspected Osteomyelitis of the Foot earlier detection of neuropathic arthropathy changes of debris, fragmentation, disruption, and dislocation [3,17]. When metal is present in or near the area of interest, there is significant loss of image resolution that is due to a beam-hardening artifact [13]. Dual-energy CT may be useful for metal artifact reduction if available. With high- resolution multiplanar imaging, CT is able to delineate the anatomic extent of soft-tissue infections. Contrast is preferred for the evaluation of soft-tissue infection and delineation of fluid collections [16]. MRI Foot MRI with or without enhancement is the favored modality in this variant and has demonstrated high sensitivity (90%) and specificity (83%) for early osteomyelitis in a large meta-analysis [23]. MRI with or without enhancement demonstrates excellent soft-tissue contrast and sensitivity to marrow abnormalities [18,19] with high-resolution detail in multiple anatomic planes. Normal marrow signal reliably excludes osteomyelitis [20]. Positive cases of osteomyelitis demonstrate decreased T1-weighted bone marrow signal and increased signal on fluid-sensitive sequences [21,22].