0:00

So over the 45 minutes that we have together,

0:03

I'm gonna cover the classic MRI appearance of both acute

0:07

and chronic osteomyelitis, as well as address some

0:11

of the more recent changes in terminology,

0:13

which have been put forth by the 2021 SSR white paper

0:18

for musculoskeletal infection.

0:20

And then subsequently apply what we have learned

0:23

to the clinical settings of both the diabetic foot

0:26

and also the neuropathic foot.

0:29

I know that this is an MRI conference,

0:31

but you can't talk about osteomyelitis without

0:35

bringing up conventional radiography.

0:38

Our x-rays of feet are going to be our major workhorse

0:43

for following and also diagnosing osteomyelitis.

0:47

These are readily available and inexpensive,

0:50

and I particularly like them

0:52

because they can serve as a useful comparison, can line all

0:56

of them up, uh, in a row from like the most recent

1:00

to the oldest images that you have so that you can watch

1:04

what has been happening to the foot, uh,

1:07

or the extremity over the course of time.

1:10

And this is sometimes much easier than looking at one

1:15

thin slight section of an MRI at one time

1:18

and then having to scroll back

1:19

and forth between two different MRI examinations.

1:24

This also helps, uh, define the postoperative anatomy

1:28

and um, we'll see another example of that in the future.

1:33

CT is one of our ER favorites

1:36

because of its speed,

1:38

so they love getting this examination such

1:41

because they can get it fast.

1:43

It is a little bit better at detecting erosions

1:47

and periosteal reaction

1:49

as we can see in this particular case, both on the axial

1:52

and the coronal and sidal reformatted images.

1:56

However, um, we don't like to use this as often.

2:01

Some also say that this is also very useful

2:04

for guiding bone biopsies,

2:06

but the literature from 2019 is a little bit debatable as,

2:11

as far as is it really useful.

2:15

So these two authors showed about a positivity rate

2:19

for these biopsies between 18 and about 30%.

2:23

And only about 30% of these patients, um,

2:27

had an actual change in their antibiotic regimen based on

2:32

the culture results.

2:34

And in the second study by Hirschfield etal,

2:37

even those patients who did not have a positive culture,

2:42

they were treated with antibiotics anyway.

2:45

So it is, uh, it is just another tool in our toolbox

2:49

and sometimes we're going to have to use it.