Soonchunhyang Med Sci.  2024 Jun;30(1):7-12. 10.15746/sms.24.002.

Histological Findings of Osteomyelitis in Patients with Diabetic Foot and Their Correlation with Radiologic Findings

• Kim K
• Lee E
• Won SH
• Park SB
• Choi IH

• KMID: 2556922
• DOI: http://doi.org/10.15746/sms.24.002

Abstract

Objective
Osteomyelitis in patients with diabetic foot has been diagnosed clinically, radiologically, and histologically. However, the accuracy of these diagnostic modalities is not well established. In this study, we histologically reviewed patients who underwent surgical procedures for diabetic foot osteomyelitis and correlated these histological features with radiological findings.
Methods
Eighty patients who were clinically diagnosed with diabetic foot osteomyelitis, who underwent surgical treatment between November 2017 and February 2022, were enrolled. Hematoxylin and eosin-stained slides and radiological findings were reviewed.
Results
Eighty patients were radiologically examined by magnetic resonance imaging (MRI) (49 cases) and/or ^99mTc-hexamethyl-propylene amine oxime-labeled white blood cells single-photon emission computed tomography (SPECT)/computed tomography (CT) (65 cases). MRI findings were suggestive of osteomyelitis in 35 cases (71.4%) and soft tissue inflammation in 46 cases (93.8%). In SPECE/CT, 60 cases (92.3%) and 64 cases (98.4%) showed signs of osteomyelitis and soft tissue inflammation, respectively. Histologically, both bone and soft tissue lesions were found in 32 cases (40%), only bone tissue lesions in seven cases (8.8%), and only soft tissue lesions in 40 cases (50%). The sensitivity and specificity of MRI for osteomyelitis were 83.3% (10/12) and 28.6% (4/14), and that of SPECT/CT was 100.0% (12/12) and 12.5% (2/16), respectively. Moreover, those of by MRI findings for soft tissue inflammation were 90.6% (29/32) and 0% (0/12), while that of SPECT/CT was 97.4% (38/39) and 0% (0/18), respectively.
Conclusion
For accurate histological diagnosis of diabetic foot osteomyelitis, sufficient specimens should be obtained. White blood cell SPECT/CT seems to be a more sensitive modality than MRI for the detection of osteomyelitis.

Keyword

Diabetes mellitus; Leukocytes; Magnetic resonance imaging; Osteomyelitis; Single-photon emission computed tomography; Computed tomography