Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2024 Oct;53(10):1979-1990.
doi: 10.1007/s00256-023-04518-x. Epub 2023 Nov 25.

How to do and evaluate DWI and DCE-MRI sequences for diabetic foot assessment

Teodoro Martín-Noguerol  1 , Carolina Díaz-Angulo  2 , Cristina Vilanova  3 , Ariadna Barceló  4 , Joaquim Barceló  5 , Antonio Luna  6 , Joan C Vilanova  5
Affiliations
Review

How to do and evaluate DWI and DCE-MRI sequences for diabetic foot assessment

Teodoro Martín-Noguerol et al. Skeletal Radiol. 2024 Oct.

Abstract

MRI evaluation of the diabetic foot is still a challenge not only from an interpretative but also from a technical point of view. The incorporation of advanced sequences such as diffusion-weighted imaging (DWI) and dynamic contrast-enhanced (DCE) MRI into standard protocols for diabetic foot assessment could aid radiologists in differentiating between neuropathic osteoarthropathy (Charcot's foot) and osteomyelitis. This distinction is crucial as both conditions can coexist in diabetic patients, and they require markedly different clinical management and have distinct prognoses. Over the past decade, several studies have explored the effectiveness of DWI and dynamic contrast-enhanced MRI (DCE-MRI) in distinguishing between septic and reactive bone marrow, as well as soft tissue involvement in diabetic patients, yielding promising results. DWI, without the need for exogenous contrast, can provide insights into the cellularity of bone marrow and soft tissues. DCE-MRI allows for a more precise evaluation of soft tissue and bone marrow perfusion compared to conventional post-gadolinium imaging. The data obtained from these sequences will complement the traditional MRI approach in assessing the diabetic foot. The objective of this review is to familiarize readers with the fundamental concepts of DWI and DCE-MRI, including technical adjustments and practical tips for image interpretation in diabetic foot cases.

Keywords: Diabetic foot; Diffusion; MRI; Neuropathic osteoarthropathy; Perfusion.

PubMed Disclaimer

References

    1. Edmonds M, Manu C, Vas P. The current burden of diabetic foot disease. J Clin Orthop Trauma. 2021;17:88–93. - DOI - PubMed - PMC
    1. Normahani P, Shalhoub J. Diabetic foot disease. Surg. 2022; pp. 53–61. (United Kingdom). https://doi.org/10.1016/j.mpsur.2021.11.007 .
    1. Syauta D, Mulawardi, Prihantono, Hendarto J, Mariana N, Sulmiati, et al. Risk factors affecting the degree of diabetic foot ulcers according to Wagner classification in diabetic foot patients. Med Clin Pract. 2021;4. https://doi.org/10.1016/j.mcpsp.2021.100231 .
    1. Abdel Razek AAK, Samir S. Diagnostic performance of diffusion-weighted MR imaging in differentiation of diabetic osteoarthropathy and osteomyelitis in diabetic foot. Eur J Radiol. Elsevier Ireland Ltd; 2017;89:221–5. https://doi.org/10.1016/j.ejrad.2017.02.015 .
    1. Pierre-Jerome C, Reyes EJ, Moncayo V, Chen ZN, Terk MR. MRI of the cuboid bone: analysis of changes in diabetic versus non-diabetic patients and their clinical significance. Eur J Radiol. 2012;81:2771–5. https://doi.org/10.1016/j.ejrad.2011.10.001 . (Elsevier Ireland Ltd). - DOI - PubMed

MeSH terms

LinkOut - more resources