MRI tops X-ray for assessment of active Charcot neuro-osteoarthropathy

Charcot neuropathic osteoarthropathy (CNO) is a rare destructive joint disorder initiated by trauma to a neuropathic extremity. It can lead to dislocations and fractures of the foot. The Charcot foot syndrome is a complex complication of diabetes and neuropathy. Its destructive effects on the foot and ankle begin with a cycle of uncontrolled inflammation.

Commonly fractures are diagnosed by simple X-ray methods however the rare neuropathic osteoarthropathy needs a better diagnostic way for its management. Correct diagnosis and treatment of acute Charcot are imperative to decrease permanent foot deformity and allow for a stable and plantigrade foot that is suitable for ambulation.

A new study in Diabetes Care compared X-ray and MRI as diagnostic tests of active CNO in diabetes. The study suggests MRI is a far more superior and reliable in diagnosing CNO in diabetic people. The X-ray imaging yielded normal findings for 79% of the bones that showed evidence of bone marrow edema on MRI.

Researchers compared X-rays and MRI scans of 48 participants were rated for severity of fracture (0 = no fracture, 1 = fracture, 2 = collapse/fragmentation), and for absence/presence of bone marrow edema (BME) on MRI and absence/presence of bone injury on X-ray. The agreement between modalities was assessed with tests for symmetry, marginal homogeneity, and κ-coefficients.