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Initial Report on the Use of In-Office Cone Beam Computed Tomography for Early Diagnosis of Osteomyelitis in Diabetic Patients

Chia-Ding Shih California School of Podiatric Medicine at Samuel Merritt University, Oakland, CA. Dr. Shih is now with DVA Greater Los Angeles Healthcare System Podiatry Residency Program, Los Angeles, CA. Dr. Bazarov is now with Kaiser San Francisco Bay Area Foot and Ankle Residency Program, Oakland, CA.

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Irina Bazarov California School of Podiatric Medicine at Samuel Merritt University, Oakland, CA. Dr. Shih is now with DVA Greater Los Angeles Healthcare System Podiatry Residency Program, Los Angeles, CA. Dr. Bazarov is now with Kaiser San Francisco Bay Area Foot and Ankle Residency Program, Oakland, CA.

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Tara Harrington California School of Podiatric Medicine at Samuel Merritt University, Oakland, CA. Dr. Shih is now with DVA Greater Los Angeles Healthcare System Podiatry Residency Program, Los Angeles, CA. Dr. Bazarov is now with Kaiser San Francisco Bay Area Foot and Ankle Residency Program, Oakland, CA.

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Mher Vartivarian Department of Medicine, California School of Podiatric Medicine at Samuel Merritt University, Oakland, CA.

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Alexander M. Reyzelman Department of Medicine, California School of Podiatric Medicine at Samuel Merritt University, Oakland, CA.

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Osteomyelitis is one of the most feared sequelae of diabetic foot ulceration, which often leads to lower-extremity amputation and disability. Early diagnosis of osteomyelitis increases the likelihood of successful treatment and may limit the amount of bone resected, preserving ambulatory function. Although a variety of techniques exist for imaging the diabetic foot, standard radiography is still the only in-office imaging modality used today. However, radiographs lack sensitivity and specificity, making it difficult to diagnose bone infection at its early stages. In this report, we describe our initial experience with a cone beam computed tomography (CBCT)–based device, which may serve as an accurate and readily available tool for early diagnosis of osteomyelitis in a patient with diabetes. Two patients with infected diabetic foot ulcers were evaluated for osteomyelitis using radiography and CBCT. Positive imaging findings were confirmed by bone biopsy. In both patients, CBCT captured early osteolytic changes that were not apparent on radiographs, leading to early surgical intervention and successful treatment. The CBCT was helpful in facilitating detection and early clinical intervention for osteomyelitis in two diabetic patients with foot ulcers. These results are encouraging and warrant future evaluation.

Corresponding author: Alexander M. Reyzelman, DPM, California School of Podiatric Medicine at Samuel Merritt University, 450 30th St, 3rd Floor, Oakland, CA 94609. (E-mail: reyzelman@samuelmerritt.edu)
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