Magnetic Resonance Imaging for the Diagnosis of Osteomyelitis in the Diabetic Patient with a Foot Ulcer

Twenty-seven diabetic patients (12 males and 15 females) with clinically suspected osteomyelitis complicating soft tissue infection of the foot underwent 29 magnetic resonance imaging studies of the suspected lesion. Of these patients, 26 had plain film radiographs, 11 had technetium bone scanning, and 12 had indium-labeled leukocyte scintigraphy performed within 2 weeks of the magnetic resonance imaging. Definitive diagnosis of the presence or absence of osteomyelitis was obtained on the basis of surgical findings, histological evidence, or resolution with nonoperative therapy. Magnetic resonance imaging was 90% accurate (sensitivity 77%, specificity 100%) in the diagnosis of osteomyelitis in this patient population. Technetium bone scan was 45% accurate (sensitivity 100%, specificity 25%); indium-labeled leukocyte scintigraphy was 50% accurate (80% sensitivity, 29% specificity); and plain film roentgenography was 73% accurate (60% sensitivity, 81% specificity). Magnetic resonance imaging is a powerful, noninvasive tool for determining the presence or absence of osteomyelitis in the patient with a diabetic foot ulcer.