Role of Magnetic Resonance Diffusion Tensor Imaging in Differentiating Osteomyelitis from Osteoarthropathy in Diabetic Foot

Mona Mohamed Hamid Ibrahim Barakat, M.B.B.CH Resident of Diagnostic and Interventional Radiology, Ministry of Health, EgyptFollow
Saher Ebrahim Taman, Professor of Diagnostic and Interventional Radiology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
Samer Abdelhamid Regal, Professor of Vascular Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt
Ahmed Galal Sadek, Professor of Diagnostic and Interventional Radiology, Faculty of Medicine, Mansoura University, Mansoura, Egypt

Subject Area

Radiodiagnosis

Article Type

Original Study

Abstract

Background: Diabetic foot ulcer (DFU) represents a major cause of preventable morbidity among adults with diabetes mellitus (DM). Diabetic foot osteomyelitis (DFO) frequently arises through contiguous spread of soft tissue infection to the underlying bone. Diffusion tensor imaging (DTI) is an advanced magnetic resonance imaging (MRI) technique that enables quantitative evaluation of tissue microstructure. Aim: To assess the diagnostic value of magnetic resonance DTI in differentiating osteomyelitis from acute osteoarthropathy in patients with diabetic foot complications. Methods: This prospective study included 28 diabetic patients presenting with clinically suspected foot complications. According to the final diagnosis, patients were classified into two groups: acute diabetic osteoarthropathy (n =14) and DFO (n =14). All patients underwent plain radiography and non-contrast MRI, including DTI sequences. Fractional anisotropy (FA) and mean diffusivity (MD) values were measured and statistically compared between groups. Results: DTI parameters demonstrated significant differences between the two groups. The mean FA was lower in osteoarthropathy cases (0.283±0.10) compared with DFO (0.361±0.084), whereas the mean MD was higher in osteoarthropathy (1.22± 0.17×10⁻³ mm²/s) than in DFO (0.883± 0.11×10⁻³ mm²/s). Receiver operating characteristic (ROC) curve analysis showed moderate diagnostic performance of FA (AUC =0.732) with 78.6% sensitivity, 68.8% specificity, and 71.4% accuracy at a cut-off ≤ 0.363. MD exhibited excellent diagnostic performance (AUC=0.934) with 85.7% sensitivity, 92.9% specificity, and 89.3% accuracy at a cut-off ≥ 1.02. Conclusion: Magnetic resonance DTI provides significant added value in differentiating osteomyelitis from acute osteoarthropathy in diabetic foot patients. MD demonstrates superior diagnostic performance compared with FA.

Recommended Citation

Barakat, Mona Mohamed Hamid Ibrahim; Taman, Saher Ebrahim; Regal, Samer Abdelhamid; and Sadek, Ahmed Galal (2025) "Role of Magnetic Resonance Diffusion Tensor Imaging in Differentiating Osteomyelitis from Osteoarthropathy in Diabetic Foot," Mansoura Medical Journal: Vol. 55 : Iss. 4 , Article 9.
Available at: https://doi.org/10.58775/2735-3990.1496