Follow up of MRI bone marrow edema in the treated diabetic Charcot foot – a review of patient charts

Figures & data

Table 1. Patients’ characteristics.

Persons, n	37
Gender, f/m, n	21/16
Age, years. Median (range)	59 (37–81)
Diabetes-type 1/2, n	17/19
No diabetes, n	1
Co-morbidity:
Obesity (BMI>30), n	10
Kidney-failure (or -transplantation), n	5

BMI: body mass index.

Table 2. Agreement of the expert’s MRI scan readings (n = 30) with the respective MRI reports on file.

Proportions of readings
Confirming principal EESC: 100%
Recording less EESC: 30%
Recording other EESC: 17%
Confirming overall temporal changes of EESC: 100%

MRI: magnetic resonance imaging.

Figure 1. (a) Baseline diagnostic MRI of active-stage Charcot foot grade 0, four weeks after symptom onset. Sagittal STIR sequence showing EESC of tarsal bones (bright appearance), and soft tissue. (b) Same foot as in (a). First follow-up MRI after 6 weeks of unloading and immobilizing. Merely unchanged EESC, as compared to (a). (c) Second follow-up MRI after 11 weeks of treatment. Regression of bone and soft EESC (as compared to (a) and (b)). Unprotected normal weight-bearing was resumed immediately, without weaning. (d) Follow-up MRI after 21 weeks of unprotected re-loading. Relapse of bone EESC, now with tarsal fractures, soft-tissue edema, and collapse of the longitudinal arch, consistent with active-stage Charcot foot grade 1.

Table 3. Time intervals between sequential FUS.

Time intervals between sequential FUS
1st−2nd MRI (1st FUS): 12 (3,5–34) weeks (n = 45)
2nd−3rd MRI (2nd FUS): 14,5 (6–42) weeks (n = 25)
3rd–4th MRI (3rd FUS): 13,5 (8–29) weeks (n = 13)
4th−5th MRI (4th FUS): 12 (8–50) weeks (n = 8)
5th−6th MRI (5th FUS): 16 (11,5–42) weeks (n = 3)
6th−7th MRI (6th FUS): 31 weeks (n = 1)

FUS: follow-up study.

Table 4. Cases and follow-up studies with regression of bone marrow EESC.

Regression of bone marrow EESC
	Yes	No^a	Total
Total cases, n	24	21	45
Cases with grade 0, n	9	8	17
Cases with grade 1, n	15	13	28
Cases related to renal failure^b	3	6	9
Total (1st to 6th) FUS, n	66	29	95
1st FUS, n	30	15	45
2nd FUS, n	17	8	25
3rd FUS, n	9	4	13
4th to 6th FUS, n	10	2	12

^aprogressing, migrating, or stagnant EESC on isolated follow-up studies (FUS).

^bin patients with preterminal kidney failure, kidney-transplantation or kidney-pancreas-transplantation.

EESC = edema equivalent signal changes.