Role of MRI in the evaluation of the musculoskeletal manifestations of Diabetic Foot

Abstract

Diabetes Mellitus is a complex disease, it affects various organs resulting in a group of related complications. The manifestations of diabetes are visible in every system in the human body; however, the musculoskeletal system is particularly affected. In the diabetic patient all the structures of the locomotor system can be damaged including the muscles, the cartilages, the tendons, the ligaments and the bone marrow. The foot is a frequent target of the disease. The diabetic foot can be considered as distinct entity, because of the variety of derangements detected clinically. Because of the progressive character of the changes taking place in the diabetic foot, early diagnosis is also essential in order to implement prompt and appropriate medical care and to avoid amputation, which is associated with considerable morbidity. Patients with DM are predisposed to peripheral neuropathies, which can eventually lead to denervation of muscle. In the acute phase, muscle denervation may not show any abnormality on MR imaging. In the subacute phase, diffuse oedema is seen in the affected muscle, which appears hyperintense on T2-W and inversion recovery sequences.irreversible chronic atrophy with associated infiltration of fat may result. On MR imaging, a larger amount of fat (with typical high T1-W signal intensity) is seen within the involved muscle bellies, with corresponding reduced muscle bulk. Bacterial myositis may be secondary to contiguous spread of infection from adjacent tissues (e.g. subcutaneous abscessand osteomyelitis). It commonly leads to intramuscular abscess formation, i.e. pyomyositis.In pyomyositis, focal rim-enhancin