Advertisement
-
1
Rafehi H, El-Osta A, Karagiannis TC: Genetic and epigenetic events in diabetic wound healing. Int Wound J 8: 12, 2011.
-
2
Lavery LA, Armstrong DG, Peters EJ, et al: Probe-to-bone test for diagnosing diabetic foot osteomyelitis: reliable or relic? Diabetes Care 30: 270, 2007.
-
3
Butalia S, Palda VA, Sargeant RJ, et al: Does this patient with diabetes have osteomyelitis of the lower extremity? JAMA 299: 806, 2008.
-
4
Dinh MT, Abad CL, Safdar N: Diagnostic accuracy of the physical examination and imaging tests for osteomyelitis underlying diabetic foot ulcers: meta-analysis. Clin Infect Dis 47: 519, 2008.
-
5
Kapoor A, Page S, Lavalley M, et al: Magnetic resonance imaging for diagnosing foot osteomyelitis: a meta-analysis. Arch Intern Med 167: 125, 2007.
-
6
Fujii, M, Armsrong DG, Terashi H: Efficacy of magnetic resonance imaging in diagnosing diabetic foot osteomyelitis in the presence of ischemia. J Foot Ankle Surg 52: 717, 2013.
-
7
Chin JA, BE Sumpio: Diabetes mellitus and peripheral vascular disease: diagnosis and management. Clin Podiatr Med Surg 31: 11, 2014.
-
8
Ganz SD: Cone beam computed tomography-assisted treatment planning concepts. Dental Clin North Am 55: 515, 2011.
-
9
Merrett SJ, Drage NA, Durning P: Cone beam computed tomography: a useful tool in orthodontic diagnosis and treatment planning. J Orthod 36: 202, 2009.
-
10
Hatcher DC: Cone beam computed tomography: craniofacial and airway analysis. Dent Clin North Am 56: 343, 2012.
-
11
Zbijewski W, De Jean P, Prakash P, et al: A dedicated cone-beam CT system for musculoskeletal extremities imaging: design, optimization, and initial performance characterization. Med Phys 38: 4700, 2011.
-
12
De Cock J, Mermuys K, Goubau J, et al: Cone-beam computed tomography: a new low dose, high resolution imaging technique of the wrist, presentation of three cases with technique. Skeletal Radiol 41: 93, 2012.
-
13
Carrino JA, Al Muhit A, Zbijewski W, et al: Dedicated cone-beam CT system for extremity imaging. Radiology 270: 816, 2014.
-
14
Tuominen EK, Kankare J, Koskinen SK, et al: Weight-bearing CT imaging of the lower extremity. AJR Am J Roentgenol 200: 146, 2013.
-
15
Loredo RA, Garcia G, Chhaya S: Medical imaging of the diabetic foot. Clin Podiatr Med Surg 24: 397, 2007.
-
16
Ertugrul BM, Lipsky BA, Savk O: Osteomyelitis or Charcot neuro-osteoarthropathy? differentiating these disorders in diabetic patients with a foot problem. Diabet Foot Ankle (Nov 5): 4, 2013.
-
17
Radiological Society of North America Inc: Radiation dose in X-ray and CT exams. Available at: http://www.radiologyinfo.org/en/safety/?pg=sfty_xray. Accessed December 13, 2014.
Initial Report on the Use of In-Office Cone Beam Computed Tomography for Early Diagnosis of Osteomyelitis in Diabetic Patients
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.
