The Value of Apparent Diffusion Coefficient from Diffusion-Weighted Imaging in Differentiating Osteomyelitis and Reactive Bone Marrow Edema in Diabetic Patients

Articles in Press

Document Type : RESEARCH PAPER

Authors

1 Department of Radiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

2 Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

3 Department of Radiology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

10.22038/abjs.2025.70340.3300

Abstract

Objectives: Herein, we evaluated the diagnostic performance of apparent diffusion coefficient (ADC) for distinguishing osteomyelitis and reactive bone marrow edema (RBME).

Methods: This cross-sectional study consisted of three groups of consecutive patients with diabetic foot ulcer (DFU) and either osteomyelitis, RBME, or healthy bone. All patients had DFU and were referred for magnetic resonance imaging. Patients with pre-MRI foot surgery or biopsy, with antibiotic therapy for three days before obtaining, and contraindication to MRI were excluded. The presence of osteomyelitis was confirmed by tissue biopsy and the diagnosis of RBME was exclusive. All patients underwent diffusion-weighted imaging (DWI) and ADC was measured and validated by two radiologists who were blinded to the diagnosis. Finally, the diagnostic performance of ADC was evaluated.

Results: In total, 45 patients with DFU were recruited of which 18 (40%) had osteomyelitis, 16 (35.6%) had RBME, and 11 (24.4%) had healthy bone tissue. We found that osteomyelitis had higher ADC values compared to normal bone (P value < 0.001) and lower ADC values compared to RBME (P value < 0.001). With the cut-off point of 1478.0 × 10-6 mm2/s, ADC differentiated osteomyelitis from RBME with an accuracy of 88.2%, a sensitivity of 94.4%, a specificity of 81.2%, and an AUC of 0.958.

Conclusion: Our results suggest the applicability of DWI as a non-invasive accurate tool for differentiating osteomyelitis from RBME.

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The Archives of Bone and Joint Surgery

Articles in Press, Accepted Manuscript
Available Online from 05 October 2025

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History

  • Receive Date: 13 August 2024
  • Revise Date: 24 February 2025
  • Accept Date: 13 April 2025

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