OBJECTIVE: To investigate the role of ultrasound in the diagnosis of osteomyelitis in the diabetic foot compared with magnetic resonance imaging (MRI), bone scintigraphy (BS), and plain film radiography (PFR). RESEARCH DESIGN AND METHODS: We investigated 19 consecutive diabetic patients (2 women, 17 men, age 60.7 +/- 9.8 years, BMI 27.0 +/- 3.8 kg/m2) with clinical suspicion of bone infection of the foot. A high-resolution ultrasound system (Esaote/Biosound, Munich) with a linear array transducer up to 13.0 MHz was used. The prospective and blinded results of each method were compared with histopathology as the reference method after metatarsal resection. RESULTS: In 14 of 19 patients, histopathology confirmed osteomyelitis. Ultrasound showed a sensitivity of 79% (PFR, 69%; BS, 83%; MRI, 100%), a specificity of 80% (PFR, 80%; BS, 75%; MRI, 75%), a positive predictive value of 92% (PFR, 90%; BS, 91%; MRI, 93%), and a negative predictive value of 57% (PFR, 50%; BS, 60%; MRI, 100%). CONCLUSIONS: Our data indicate that ultrasound might have a better diagnostic power for detecting chronic osteomyelitis in the diabetic foot than PFR and has similar sensitivity and specificity as BS. MRI is superior to the other three methods. We conclude that the use of ultrasound in the management of the diabetic foot is worthy of further investigation.
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Abstract|
February 01 1999
Correlation of imaging techniques to histopathology in patients with diabetic foot syndrome and clinical suspicion of chronic osteomyelitis. The role of high-resolution ultrasound.
M D Enderle;
M D Enderle
Department of Internal Medicine, University of Tübingen, Germany.
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S Coerper;
S Coerper
Department of Internal Medicine, University of Tübingen, Germany.
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H P Schweizer;
H P Schweizer
Department of Internal Medicine, University of Tübingen, Germany.
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A E Kopp;
A E Kopp
Department of Internal Medicine, University of Tübingen, Germany.
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M H Thelen;
M H Thelen
Department of Internal Medicine, University of Tübingen, Germany.
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C Meisner;
C Meisner
Department of Internal Medicine, University of Tübingen, Germany.
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H Pressler;
H Pressler
Department of Internal Medicine, University of Tübingen, Germany.
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H D Becker;
H D Becker
Department of Internal Medicine, University of Tübingen, Germany.
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C Claussen;
C Claussen
Department of Internal Medicine, University of Tübingen, Germany.
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H U Häring;
H U Häring
Department of Internal Medicine, University of Tübingen, Germany.
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D Luft
D Luft
Department of Internal Medicine, University of Tübingen, Germany.
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Citation
M D Enderle, S Coerper, H P Schweizer, A E Kopp, M H Thelen, C Meisner, H Pressler, H D Becker, C Claussen, H U Häring, D Luft; Correlation of imaging techniques to histopathology in patients with diabetic foot syndrome and clinical suspicion of chronic osteomyelitis. The role of high-resolution ultrasound.. Diabetes Care 1 February 1999; 22 (2): 294–299. https://doi.org/10.2337/diacare.22.2.294
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