Assessment of pelvic floor dysfunctions using dynamic magnetic resonance imaging

Purpose

The purpose of this study was to assess pelvic floor dysfunction using dynamic MRI.

Material and methods

A prospective study was carried out on 21 consecutive patients presented during February 2013 to June 2013 with pelvic pain, difficulty in defecation, constipation or organ prolapse. Pelvic floor was imaged using T2-weighted and fast imaging employing steady-state acquisition sequences. Pubococcygeal line was used as the line of reference which further allowed measurement of width and vertical descent of levator hiatus. Anorectal angle was measured to assess relaxation and contraction of puborectalis muscle. Grading of prolapse was classified as mild, moderate and severe. All data were recorded both in resting and during straining phase.

Results

A total of 21 patients were studied, with a mean age of 37.3 (9.4) years with 15 (71.4%) females and 6 (21%) males. Dynamic MR revealed cystocele and rectocele in 7 (33.3%) patients, each. Three (14.28%) patients had enteroceles and spastic pelvic syndrome, each. Only one patient (4.76%) had descending perineal syndrome. Intussusception was observed in 10 (47.6%) patients with commonest type being intra rectal seen in 7 (33.3%) patients.

Conclusion

Dynamic MRI is an ideal, non invasive technique which does not require patient preparation for evaluation of pelvic floor. It acts as one stop shop for diagnosing single or multiple pelvic compartment involvement in patients with pelvic floor dysfunction.     

Dynamic magnetic resonance imaging for assessment of minimally invasive pelvic floor reconstruction with polypropylene implant

Introduction

The purpose of the study was to assess the usefulness of dynamic MRI in patients with pelvic organ prolapse after pelvic floor repair with polypropylene mesh.

Materials and methods

Fifteen consecutive patients (mean age 66.5 years) who were scheduled for either anterior (n = 9) or posterior (n = 6) pelvic floor repair were prospectively evaluated by clinical assessment and dynamic MRI 1 day before and 3 months after surgery. MRI diagnoses and MRI measurements of relevant anatomical points at rest and on straining were analysed before and after surgery.

Results

At follow-up assessment 93.3% of all patients were clinically cured. Dynamic MRI showed newly developed (n = 6) or increased (n = 6) pelvic organ prolapse in 80% (n = 12) of all patients 3 months after pelvic floor repair. Most of them (n = 11; 91.7%) affected the untreated pelvic floor compartment. On straining anatomical points of reference in the anterior pelvic floor compartment were significantly (p < 0.05) elevated after anterior repair and rectal bulging was significantly (p = 0.036) reduced after posterior pelvic floor repair.

Conclusions

In this study dynamic MRI could verify the effective support of anterior and posterior pelvic floor structures by anterior and posterior polypropylene implant respectively. But dynamic MRI demonstrates if one compartment of the pelvic floor is repaired another compartment frequently (73.3%) develops dysfunction. These results did not correspond to clinical symptoms on short-term follow-up (3 months). Studies with long-term follow-up are necessary to prove if dynamic MRI can reliably identify clinically significant pelvic organ prolapse after pelvic floor repair before the onset of symptoms.     

A two-stage imaging protocol for evaluating women presenting with acute pelvic pain

Purpose

To evaluate a two-stage imaging protocol for diagnosing women presenting with acute pelvic pain.

Materials and methods

Forty-nine female patients aged 20–49 years (mean 29.5 years) who were presenting with acute pelvic pain underwent US examination of the pelvis. MRI of the pelvis was done for seventeen patients with indeterminate ultrasound findings. Data from both MRI and US were obtained, and the definite diagnosis was established with laparoscopic or surgical findings and results of clinical follow-up as the reference standard.

Results

Positive pelvic US and MRI findings for gynecological causes were seen in thirty-six out of forty-nine cases (36/49). Final diagnoses of our positive cases (36) were as follows: hemorrhagic ovarian cyst seven cases (19%), ovarian torsion five cases (14%), endometriosis five cases (14%), teratodermoid four cases (11%), ectopic pregnancy four cases (11%), tubo-ovarian abscess three cases (8%), degenerating fibroid three cases (8%), adenomyosis two cases (6%), pedunculated prolapsed submucosal fibroid one case (3%), uterine AVM one case (3%) and pelvic hematoma one case (3%), Thirteen cases (13/49) were excluded from the study as they had other non gynecological causes of pelvic pain like appendicitis, lower ureteric stones, crohn’s disease and diverticulitis. In 19 cases the diagnosis was established with US alone and so MRI was done for the remaining 17 cases where US was inconclusive.

Conclusion

A two-stage protocol for evaluating women presenting with acute pelvic pain with the use of ultrasonography first, and then MRI for cases with inconclusive ultrasound findings, will optimize diagnostic accuracy.     

Feasibility of 3.0T pelvic MR imaging in the evaluation of endometriosis

Introduction

Endometriosis represents an important clinical problem in women of reproductive age with high impact on quality of life, work productivity and health care management. The aim of this study is to define the role of 3 T magnetom system MRI in the evaluation of endometriosis.

Materials and methods

Forty-six women, with transvaginal (TV) ultrasound examination positive for endometriosis, with pelvic pain, or infertile underwent an MR 3.0 T examination with the following protocol: T2 weighted FRFSE HR sequences, T2 weighted FRFSE HR CUBE 3D sequences, T1 w FSE sequences, LAVA-flex sequences. Pelvic anatomy, macroscopic endometriosis implants, deep endometriosis implants, fallopian tube involvement, adhesions presence, fluid effusion in Douglas pouch, uterus and kidney pathologies or anomalies associated and sacral nervous routes were considered by two radiologists in consensus. Laparoscopy was considered the gold standard.

Results

MRI imaging diagnosed deep endometriosis in 22/46 patients, endometriomas not associated to deep implants in 9/46 patients, 15/46 patients resulted negative for endometriosis, 11 of 22 patients with deep endometriosis reported ovarian endometriosis cyst. We obtained high percentages of sensibility (96.97%), specificity (100.00%), VPP (100.00%), VPN (92.86%).

Conclusion

Pelvic MRI performed with 3 T system guarantees high spatial and contrast resolution, providing accurate information about endometriosis implants, with a good pre-surgery mapping of the lesions involving both bowels and bladder surface and recto-uterine ligaments.     

Comparison of diagnostic accuracy of Magnetic Resonance Imaging and Multidetector Computed Tomography in the detection of pelvic fractures

Objective

To compare diagnostic accuracy and interobserver reliability of Magnetic Resonance Imaging (MRI) and Multidetector Computed Tomography (MDCT) in the detection of acute pelvic fractures.

Materials and methods

In 38 consecutive patients (mean age 74.7 years) with a positive finding of anterior pelvis fracture in the conventional X-rays, pelvic MRI and MDCT were performed for further evaluation of pelvic ring fractures. Two radiologists independently read all data sets. Sensitivity and specificity were calculated based on mean scores for each method. Sensitivities of CT and MRI were compared using a paired proportion test (McNemar). Diagnostic validity of both methods was assessed by the interobserver variability using kappa statistics. Combined clinical data and findings from all imaging studies served as the reference standard.

Results

122 fractures were identified in the reference standard (37 sacral, 58 pubic, 22 acetabular, 1 ischial, 4 ilial). On average, MRI detected 96.3% whereas CT detected 77% of all fractures. With regard to sensitivity, MRI proved to be significantly better compared to MDCT (observer 1, p = 0.0009; observer 2, p = 0.0003 by observer 2). In particular, MRI performed better in the depiction of sacral fractures, reaching a sensitivity of 98.6% compared to 66.1% at CT. The interobserver variability was determined to be very good (k = 0.955 for MRI and 0.902 for MDCT).

Conclusion

MRI reaches a significantly higher sensitivity than CT in the detection of acute pelvic fractures, particularly of the sacrum. Especially in elderly patients with suspicion of a sacral fracture and negative results at MDCT, MRI may be considered as the next step in diagnostic workup.     

Imaging of the posterior pelvic floor

Disorders of the posterior pelvic floor are relatively common. The role of imaging in this field is increasing, especially in constipation, prolapse and anal incontinence, and currently imaging is an integral part of the investigation of these pelvic floor disorders. Evacuation proctography provides both structural and functional information for rectal voiding and prolapse. Dynamic MRI may be a valuable alternative as the pelvic floor muscles are visualised, and it is currently under evaluation. Endoluminal imaging is important in the management of anal incontinence. Both endosonography and endoanal MRI can be used for detection of anal sphincter defects. Endoanal MRI has the advantage of simultaneously evaluating external sphincter atrophy, which is an important predictive factor for the outcome of sphincter repair. Many aspects of constipation and prolapse remain incompletely understood and treatment is partly empirical; however, imaging has a central role in management to place patients into treatment-defined groups.     

Septate or bicornuate uterus: Accuracy of three-dimensional trans-vaginal ultrasonography and pelvic magnetic resonance imaging

Objective

To estimate the accuracy of 3-dimensional transvaginal ultrasonography (3D-TVUS), hysterosalpingography (HSG) and pelvic magnetic resonance imaging (MRI) in the differentiation between septate and bicornuate uterus.

Patients and methods

Thirty-six patients with suspected septate or bicornuate uterus on 2D ultrasound or hysterosalpingography (HSG) underwent 3D-TVUS examination, MR imaging, diagnostic laparoscopy and hysteroscopy. HSG was performed only for those patients who did not undergo the procedure before (21 patients), we retrospectively revised the hysterosalpingography of 15 patients performed outside our hospital with acceptable quality.

Results

HSG showed sensitivity of 77.4%, specificity of 60% and overall accuracy of 75% in the differentiation between the septate and bicornuate uterus. MRI showed sensitivity of 93.5%, specificity of 80%, PPV of 96.6% and negative predicative value of 66.6%, with overall accuracy of 91.6%. The 3D ultrasound showed the highest diagnostic parameters, with sensitivity of 96.7%, specificity of 100%, PPV of 100% and negative predicative value of 83.3%, with overall accuracy of 97.2%.

Conclusions

Transvaginal 3-D ultrasonography is accurate for diagnosis and differentiation between septate uterus and bicornuate uterus. We recommend 3-D transvaginal ultrasonography as the first and only mandatory step in the assessment of the uterine cavity in patients with a suspected septate or bicornuate uterus, especially before planning surgery. MRI should be preserved for patients in whom 3D TVS is not possible like virgins.     

MRI role in morphological and functional assessment of the levator ani muscle: Use in patients affected by stress urinary incontinence (SUI) before and after pelvic floor rehabilitation

Objective

Pelvic floor dysfunctions affect a very high proportion of female population. Magnetic resonance imaging is the only technique able to provide a multiplanar overview of pelvic organs and muscles without the use of ionizing radiation. The aim of our prospective study is to objectively evaluate the effectiveness of perineal re-education applying MR technique.

Materials and methods

22 patients affected by stress urinary incontinence were enrolled in our prospective study. They underwent urogynaecological, urodynamic examinations, and a questionnaire about symptoms (ICIQ-UI) to investigate the degree of their interference with daily activities. Then they underwent a morphological and dynamic MR exam.

Results

The pre-perineal rehabilitation MR examinations showed an asymmetry of the levator ani muscle in 87% of patients; the remaining 13% showed a muscular bilateral volume reduction. In the group with unilateral defect, the muscle total volume had values between 15 and 21 cm³. Its overall volume was 34.2% smaller on the defective side (9.28 ± 0.26 cm³) compared to the normal side (12.64 ± 12.31 cm³, P < 0.001).In patients with a bilateral impairment, the muscle was replaced by fibro-fatty tissue, without a significant asymmetry between the two sides. The post-perineal rehabilitation MR tests showed three different degrees of response to therapy, with a “complete response” found in 67% of patients and no response in 13%.

Conclusions

MR is an useful tool in the management of patients affected by stress urinary incontinence with indication for perineal rehabilitation. Its objective data allow to distinguish different types of response to therapy and, consequently, different outcomes in terms of additional treatments.     

Imaging of the uterovaginal anomalies

Objective

To assess the role of different imaging modalities including ultrasonography, hysterosalpingogram, and magnetic resonance imaging in detection of variable Müllerian anomalies. Preoperative proper diagnosis data about Müllerian anomalies necessary for clear indications of how and when to operate.

Patients and methods

A retrospective MRI study of 34 patients was done in the period from February 2008 to February 2010, their age ranging from 3 months to 38 years (mean 24 years), with uterovaginal anomalies. Ultrasonography was performed for all cases; HSG was performed in 16 cases before MRI imaging.

Results

MRI is the most reliable method for evaluating uterovaginal anomalies, particularly in pediatrics and virgins. MRI is an accurate examination for identification and categorization of MDAs and should be carried out prior to any surgery, in this study MRI allowed correct diagnosis of 34 uterine anomalies (accuracy 100%) whereas US was correct in 30 out of 34 cases (accuracy 88%). HSG had a limited role as cannot be preformed for virgins, and cannot identify non-communicating horns in unicornuate cases.

Conclusion

MRI is the examination of choice in uterovaginal anomalies. Endovaginal ultrasound cannot be preformed for children or females who have never had sexual intercourse. TAUS have not proved completely reliable in Müllerian duct anomalies.     

Value of fusion of PET and MRI for staging of endometrial cancer: Comparison with F-FDG contrast-enhanced PET/CT and dynamic contrast-enhanced pelvic MRI

Purpose

To investigate the diagnostic value of retrospective fusion of pelvic MRI and ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) PET images for assessment of locoregional extension and nodal staging of endometrial cancer.

Materials and methods

Thirty patients with biopsy-proven endometrial cancer underwent preoperative contrast-enhanced PET/CT (PET/ceCT) and pelvic dynamic contrast-enhanced MRI for initial staging. Diagnostic performance of PET/ceCT, contrast-enhanced MRI, and retrospective image fusion from PET and MRI (fused PET/MRI) for assessing the extent of the primary tumor (T stage) and metastasis to regional LNs (N stage) was evaluated by two experienced readers. Histopathological and follow-up imaging results were used as the gold standard. The McNemar test was employed for statistical analysis.

Results

Fused PET/MRI and MRI detected 96.7% of the primary tumors, whereas PET/ceCT detected 93.3%. Accuracy for T status was 80.0% for fused PET/MRI, and MRI proved significantly more accurate than PET/ceCT, which had an accuracy of 60.0% (p = 0.041). Patient-based sensitivity, specificity and accuracy for detecting pelvic nodal metastasis were 100%, 96.3% and 96.7% for both fused PET/MRI and PET/ceCT, and 66.7%, 100% and 96.7% for MRI, respectively. These three parameters were not statistically significant (p = 1).

Conclusion

Fused PET/MRI, which complements the individual advantages of MRI and PET, is a valuable technique for assessment of the primary tumor and nodal staging in patients with endometrial cancer.     

Value of dynamic sonography in the management of shoulder pain in patients with rheumatoid arthritis

Purpose

The purpose of this study is to evaluate the role of dynamic high resolution ultrasonography in the detection of abnormalities of rheumatoid arthritis and to find out the value added to the management plan of the disease.

Patients and methods

21 shoulders of rheumatoid arthritis patients complaining of shoulder pain were scanned with ultrasound (static and dynamic) and compared to clinical examination.

Result

The most predictive sign of rheumatoid arthritis was sub-acromial impingement which was screened and graded by ultrasound in (100%). Other US signs included sub-acromial bursitis in 14.2%, biceps teno-synovitis in 52.4%, supraspinatous tendinopathy in 57.1%, supraspinatous partial thickness bursal surface tear in 14.2% and joint effusion in 9.5% of our patients. The combination of more than one finding was of higher sensitivity than isolated sign alone.

Conclusion

Dynamic ultrasound examination for the diagnosis of shoulder impingement in Rheumatoid arthritis should be done in addition to the clinical and static ultrasound examination to improve the management plan.     

Magnetic resonance imaging of cervical carcinoma using an endorectal surface coil

Introduction

The objective of this trial is to investigate the diagnostic value of magnetic resonance imaging (MRI) with an endorectal surface coil for precise local staging of patients with histologically proven cervical cancer by comparing the radiological, clinical, and histological results.

Materials and methods

Women with cervical cancer were recruited for this trial between February 2007, and September 2010. All the patients were clinically staged according to the FIGO classification and underwent radiological staging by MRI that employed an endorectal surface coil. The staging results after surgery were compared to histopathology in all the operable patients.

Results

A total of 74 consecutive patients were included in the trial. Forty-four (59.5%) patients underwent primary surgery, whereas 30 (40.5%) patients were inoperable according to FIGO and underwent primary radiochemotherapy. The mean age of the patients was 50.6 years. In 11 out of the 44 patients concordant staging results were obtained by all three staging modalities. Thirty-two of the 44 patients were concordantly staged by FIGO and histopathological examination, while only 16 were concordantly staged by eMRI and histopathological examination. eMRI overstaged tumors in 14 cases and understaged them in 7 cases.

Conclusions

eMRI is applicable in patients with cervical cancer, yet of no benefit than staging with FIGO or standard pelvic MRI. The most precise preoperative staging procedure still appears to be the clinical examination.     

直肠内注入模拟粪便的动态MRI对女性盆底痉挛综合征的诊断价值

目的 利用动态MRI研究直肠内模拟粪便注入前、后女性盆底痉挛综合征(SPFS)患者的肛直肠形态、功能性病变, 并对多盆腔器官脱垂进行评价, 明确注入球囊后的动态MRI在SPFS患者中的诊断优势。 方法 对53例临床诊断为SPFS的女性患者行动态MRI检查, 使用自行设计高顺应性球囊模拟大便, 测量患者直肠内球囊注入前、后力排相盆底的相关数据。 结果 盆底动态MRI结果显示, 53例女性SPFS患者中, 伴发多盆腔器官脱垂者24例。直肠内造影剂注入前、后力排相的肛直角变化, 差异无统计学意义(χ2=0.603, P > 0.05);相比直肠内模拟粪便注入后的盆底动态MRI, 未注入的力排相分别有18.0%(9/50)膀胱脱垂、6.1%(3/49)子宫或阴道穹窿脱垂、32.7%(17/52)直肠前膨出及14.6%(7/48)会阴体下降诊断为阴性。直肠内模拟粪便注入前、后力排相观察多盆腔器官脱垂变化, 差异均有明显统计学意义。 结论 直肠内注入模拟粪便的盆底动态MRI为女性SPFS患者提供了更全面的诊断, 为术前正确诊断盆腔多部位缺陷及术后正确评价治疗效果提供了客观依据。     

Role of novel magnetic resonance imaging sequences in characterization of ovarian masses

Introduction

Differentiating a benign from a malignant adnexal mass would provide a basis for optimal preoperative planning and may also reduce the number of unnecessary laparotomies patients undergoing treatment for benign disease. MRI provides additional information on the composition of soft-tissue masses using differences in MR relaxation properties seen in various types of tissue. More recently developed MRI sequences, like diffusion weighted, susceptibility weighted, and dynamic contrast enhancement sequences provided additional capacities for adnexal lesion tissue characterization.

Aim of the work

The aim of this work was to study the role of MRI including the novel sequences, namely dynamic contrast enhanced MRI (DCE–MRI), diffusion weighted images (DWI) and susceptibility weighted images (SWI) in the characterization of ovarian masses.

Patients and methods

This study included 25 patients having indeterminate adnexal masses at ultrasound. They were subjected to pelvic MRI, including T1, T2, T1 fat sat sequences, as well as the DWI, SWI, and DCE sequences. Final diagnosis was reached through histopathological data, or therapeutic response.

Results

All endometriomas showed blooming on SWI. All malignant lesions showed restricted diffusion and type III DCE curves.

Conclusion

MRI, especially the more recent sequences (DWI, SWI and DCE) allows accurate characterization of ovarian lesions.     

Morphologische und funktionelle Beckenbodenstörungen aus gynäkologischer Sicht

Purpose. The following article is designed to describe the diagnostics and therapy of morphological and functional defects in the female pelvic floor from a gynaecological point of view. Assessment of the relevance of imaging techniques is of particular importance. Material and methods. The main diagnoses are: in the anterior compartment of the pelvic floor, urethro- cystocele; in the middle compartment, uterine descent/prolapse or enterocele; and in the posterior compartment, rectocele. They are clinically examined by means of a standardised gynaecological examination and classified according to recommendations from the International Continence Society ( ICS) in order to obtain internationally comparable results. Comparison with the usual imaging procedures (introitus- and perineal sonography, colpocystorectography/defaecography and functional MRI of the pelvic floor) are described and critically discussed. The most important functions affected are storage and evacuation of the bladder and rectum. They are clinically examined by means of stress test and pad-weigh test and technically examined using urodynamics, sphincter-rectum manometry and EMG. Imaging procedures play a very important role here also. Results. Comparison of clinical and imaging procedures shows that the two methods are at present limited in comparability, mainly because different points of reference are used to quantify results. The line of the hymen is a good point of reference in grading descent and prolapse. During the gynaecological examination, the three compartments can readily be assessed separately by use of split gynaecological specula. This is presently practically impossible using imaging procedures. The pubococcygeal line is generally used to describe findings. Discussion. Scientific progress can only be expected if and when these problems are studied as a whole. Imaging procedures have securely established themselves in the diagnostic repertoire, but do not as yet influence therapy decisions. The indication and choice of operation depend on the severity of the patient's symptoms the clinical findings and the results of urodynamic investigations. Dynamic CTG is presently the most reliable method of showing all three compartments at rest and during function. It has largely replaced colpocystorectography. Sonography is found to be varied in ist results at the moment.     

MR排便造影在后盆腔障碍性疾病中的评估价值

后盆腔障碍疾病是以肛直肠解剖和功能异常为主的一类盆底功能障碍性疾病,伴有便秘、便失禁等临床症状。MR排便造影是一种动态MR成像方法,可对后盆腔结构形态和运动功能异常情况直观显示,能够鉴别后盆腔障碍性疾病的类型并认识其发病原因,如直肠膨出、肠疝、盆腔器官脱垂和直肠套叠、脱垂等,同时对便失禁早期的肛直肠形态学和功能学异常改变的诊断有重要提示价值。     

Uterine septum structure and reproductive performance: Role of 3D TVUS and MRI

Objective

To evaluate the role 3D TVUS and MRI in diagnosing the nature of uterine septum according to the reproductive performance with histopathological examination as the reference standard.

Patients and methods

The study included 36 patients in the reproductive age presented with infertility or recurrent pregnancy loss, and diagnosed hysteroscopically with double uterine cavity. All patients were subjected to 3D TVUS. Cases in which the diagnosis of septate uterus was not confirmed by 3DUS were excluded from the study. The remaining 29 patients confirmed to have uterine septum partial or complete were included. 3D TVUS with VOCAL, was applied in order to calculate the volume of the septum, echostructure and its vascularity index (VI). The patients were then referred to MRI examination, patients were referred to operative hysteroscopy for hysteroscopic metroplasty. Sample of septal tissue was obtained and sent for histopathological examination.

Results

The Vascularity index (VI) of the muscular septum (16.63 ± 5.7%) was significantly higher than the fibrous septum (3.6 ± 1.17%). The sensitivity, specificity, PPV, and NPV in diagnosing septate uterus were 100%, 90 %, 95%, and 100% for 3D TVUS, and 95%, 80%, 90%, and 89% for MRI respectively.

Conclusion

3D TVUS is an accurate, less expensive, and a rapid examination than MRI in diagnosing uterine septa structure, it can be considered as the reference standard in diagnosing and characterizing septate uterus.     

Improved detection of localized prostate cancer using co-registered MRI and (11)C-acetate PET/CT

Objectives

We aimed to study the ability of contrast enhanced MRI at 1.5 T and ¹¹C-acetate PET/CT, both individually and using fused data, to detect localized prostate cancer.

Methods

Thirty-six men with untreated prostate cancer and negative for metastatic disease on pelvic CT and bone scan were prospectively enrolled. A pelvic ¹¹C-acetate PET/CT scan was performed in all patients, and a contrast enhanced MRI scan in 33 patients (6 examinations using both endorectal coil and surface coils, and 27 examinations using surface coils only). After the imaging studies 10 patients underwent prostatectomy and 26 were treated by image guided external beam radiation treatment. Image fusion of co-registered PET and MRI data was performed based on anatomical landmarks visible on CT and MRI using an advanced in-house developed software package. PET/CT, MRI and fused PET/MRI data were evaluated visually and compared with biopsy findings on a lobar level, while a sextant approach was used for patients undergoing prostatectomy.

Results

When using biopsy samples as method of reference, the sensitivity, specificity and accuracy for visual detection of prostate cancer on a lobar level by contrast enhanced MRI was 85%, 37%, 73% and that of ¹¹C-acetate PET/CT 88%, 41%, 74%, respectively. Fusion of PET with MRI data increased sensitivity, specificity and accuracy to 90%, 72% and 85%, respectively.

Conclusions

Fusion of sequentially obtained PET/CT and MRI data for the localization of prostate cancer is feasible and superior to the performance of each individual modality alone.     

Evaluation of diabetic foot osteomyelitis using probe to bone test and magnetic resonance imaging and their impact on surgical intervention

Objectives

To evaluate the role of probe to bone test (PTB) and magnetic resonance imaging (MRI) in assessing the surgical intervention in diabetic foot.

Study design

102 diabetic patients were included; 42 males and 60 females, mean age was 52 ± 6, all patients were subjected to PTB test followed by MRI, the presence of osteomyelitis was assessed in relation to histopathological examination.

Results

We had 80 (75.5%) feet of osteomyelitis, PTB test was true positive in 66 (82.5%), false negative in eight and false positive in 6 feet. MRI was true positive in 78, false positive in three and false negative in two feet. Other MRI finding include abscess in 37, tenosynovitis in 69, neuropathic changes in 20 feet, and all cases had cellulites. Sensitivity, specificity, PPV and NPV were 82.5%, 76.9%, 91.7%, and 58.8% for PTB test and 97.5%, 88.5%, 96.3% and 92% for MRI respectively.

Conclusion

PTB test is a simple, minimally invasive, low cost test and can be done at outpatient clinic. Its sensitivity and specificity are good when compared to those of MRI, but when we need to diagnose associated soft tissue infection and planning the surgical management MRI was the image of choice.