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.