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Magnetic resonance imaging in early stage charcot arthropathy: correlation of imaging findings and clinical symptoms.

OBJECTIVE
To report on qualitative and quantitative MRI findings in early stage of diabetic osteoarthropathy (CA) and correlation with clinical symptoms.


MATERIALS AND METHODS
Clinical data of 13 patients (mean age = 61.2 years) with Charcot arthropathy (CA, Eichenholtz 0) were compared with findings in native and contrast-enhanced MRI. 12 patients had diabetes mellitus (7 type 2, 5 type 1), one had idiopathic polyneuropathy. Evaluation was performed at acute stage of CA and at a 4 months follow-up. After baseline assessment, patients were treated with pressure-relieving means. Mean values of signal-intensity in short T1 inversion recovery (STIR) images of bones of the foot and ankle and corresponding contrast-enhancement were evaluated. Additional MRI-findings (soft tissue edema, varicosis, tenovaginitis, joint effusion) were analyzed. A correlation with symptoms (reddening, swelling, hyperthermia, pain) was performed.


RESULTS
Bone marrow edema in affected bones significantly decreased (p<0.001). Soft tissue edema and pain showed a significant correlation with intensity of bone marrow edema (p<0.05). The presence of bone marrow edema in the STIR sequence was strongly associated with a corresponding contrast enhancement (p<0.0001, kappa-coefficients 0.976 at baseline and 0.953 at follow-up).


CONCLUSION
MRI in early stage of CA provides valuable diagnostic information on the activity of the disease. A significant correlation of intensity of bone marrow edema in MRI and some clinical parameters (soft tissue edema and pain) was found. Paramagnetic contrast-agent did not provide additional information. This is the first report on quantitative assessment of signal alterations in stage 0 CA before and after treatment.