Choosing Wisely:

Don’t routinely use MRI to diagnose bone infection (osteomyelitis) in the foot.

Rationale and Comments: When the diagnosis of osteomyelitis can be reliably established by clinical means and/or serial plain film radiographs, MRI is generally unnecessary. Furthermore, MRI is particularly poor at differentiating osteomyelitis from benign postoperative marrow edema and from marrow edema due to Charcot arthropathy. Use of MRI in these instances can lead to a false positive interpretation and potentially harmful overtreatment.
Sponsoring Organizations:
  • American Podiatric Medical Association
  • Sources:
  • IDSA guideline
  • Disciplines:
  • Infectious disease
  • Orthopedic
  • References: • Lipsky BA, et al. 2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections. CID. 2012;54:132.
    • Rogers LC, et al. The Charcot foot in diabetes. Diabetes Care. 2011;34:2123.
    • Ledermann HP, et al. Pitfalls and limitations of magnetic resonance imaging in chronic posttraumatic osteomyelitis. Eur Radiol. 2000;10:1815-23.

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