Complications Associated with Diabetic Foot: A Diagnostic Systematic Review

Abstract

Introduction: This systematic review examines nine cross-sectional studies to evaluate the role of magnetic resonance imaging (MRI) as a diagnostic tool for osteomyelitis in diabetic foot ulcers. The included studies feature varying sample sizes, age ranges, and diabetic types. Specificity, sensitivity, and predictive values were measured to assess MRI's diagnostic accuracy in this context.

Methods: In this systematic review, we conducted a comprehensive search of relevant studies in PubMed. We focused on cross-sectional studies that examined the diagnostic utility of magnetic resonance imaging (MRI) for osteomyelitis in diabetic foot ulcers. The review included nine studies with varying sample sizes, patient demographics, and types of diabetes. We assessed the specificity, sensitivity, and accuracy of MRI as a diagnostic tool in these studies. Sensitivity values ranged from 29% to 100%, specificity from 37% to 100%, and accuracy from 79% to 100%. Positive and negative predictive values were reported in selected studies.

Results: The nine cross-sectional studies encompassed patients aged between 23 and 85 years, with sample sizes ranging from 12 to 110. While seven studies did not specify the type of diabetes, two studies focused on patients with insulin-dependent diabetes. Ulceration in the diabetic population was predominantly infected, with one study addressing bacterial infection, and another investigating chronic deep-seated infection. Sensitivity values varied widely, from as low as 29% to as high as 100%, while specificity ranged from 37% to 100%. Accuracy levels reached up to 100% in certain studies, and positive and negative predictive values were reported in selected investigations. The highest sensitivity (100%) was observed in two studies, whereas the lowest sensitivity (29%) was reported in a prospective study. Additionally, the highest specificity (100%) was recorded in a study with patients suffering from bacterial infection, while the lowest specificity (37%) was identified in a study involving patients with type one and two diabetes.

Conclusions:  The reviewed studies demonstrated a wide range of sensitivity and specificity values for MRI in this context. While some studies reported high sensitivity and specificity, others showed lower specificity levels. Despite this variability, MRI remains a valuable diagnostic tool due to its ability to provide detailed anatomical information and visualize abnormalities in bone marrow, joint spaces, and soft tissue. It can aid clinicians in making informed decisions and surgical planning. However, it is essential to recognize the limitations of MRI, particularly in distinguishing between infected and non-infected bone marrow edema.