|ESSR 2015 / P-0105|
|A novel semi-quantitative scoring proforma in the assessment of radiological resolution of the acute diabetic Charcot foot|
Optimal current management of the acute diabetic Charcot foot requires accurate and timely diagnosis to allow casting for protection of the foot, prior to the development of radiographically identifiable fractures or collapse. Diagnosis and monitoring of such pre-radiographic stage Charcot (Eichenholz stage 0)1 necessitates the use of MRI or nuclear medicine techniques for early diagnosis and follow up2.
A two degree Celsius rise in skin temperature of the affected foot is used to make a clinical diagnosis of Charcot, and a fall in temperature is generally used to determine when protective casting can be safely removed1. This is, however, a relatively crude and poorly specific measure. On MR imaging, subchondral bone marrow oedema (BMO) and fractures are features of the acute Charcot foot. A reduction in bone marrow oedema has been shown to correlate with a drop in skin temperature but marrow oedema has been shown to persist in many cases, beyond clinical resolution of acute Charcot3.
However, assessment of the utility of MR for determining resolution of acute Charcot has been hampered by absence of validated methods for quantitation of MR findings that would allow comparison between baseline and follow up studies.
The aim of this study is to present and evaluate the reliability of a novel semi-quantitative BMO score and fracture score on non-contrast foot and ankle MRI scans performed at presentation and follow-up in patients with acute diabetic Charcot osteoarthropathy.