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Reevaluating Magnetic Resonance Imaging in Radiographically Suspected Osteomyelitis of the Toe

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  • 1 Department of Orthopaedics, Lenox Hill Hospital, New York, NY. Dr. Ciotola is now in private practice in Methuen, MA.
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Background:

Magnetic resonance imaging (MRI) is both sensitive and specific in the diagnosis of osteomyelitis, and it is an important imaging modality in preoperative planning of resection of infected bone. In many cases, however, the extent of osseous infection is evident on plain radiographs, and little additional information is gained from the MRI. The goal of this study was to assess the accuracy of radiographs against MRIs in assessing the spread of suspected osteomyelitis from one phalanx to another or to a metatarsal.

Methods:

A medical record review was performed, and 14 patients with 16 toes confirmed to have osteomyelitis involving one or more phalanges were included in the study. An investigator blinded to the MRI findings interpreted the extent of osseous involvement based solely on the radiographic and clinical presentation. The accuracy of the radiographic interpretation was then calculated against the MRI findings.

Results:

In 14 of the 16 toes (87.5%), whether osteomyelitis had spread from one bone to another was determined based on the radiographic and clinical presentation. In one toe, the radiograph did not adequately depict osteomyelitis in adjacent infected bone. In one more toe, the radiograph depicted features of osteomyelitis in uninfected bone.

Conclusions:

In a large percentage of patients, the phalanges affected by osteomyelitis had visible findings on the radiograph, and operative planning could have been based on the radiograph alone.

Corresponding author: Nicholas Ciotola, DPM, 386 Merrimack St Ste 1B, Methuen MA 01844. (E-mail: drnick2k@aol.com)