Magnetic resonance imaging reveals micro-haemorrhage in the feet of diabetic patients with a history of ulceration

Diabetic Medicine : a Journal of the British Diabetic Association
P D BrashJ E Tooke

Abstract

Soft tissue haemorrhage in the foot is a possible precursor of ulceration in patients with diabetic peripheral neuropathy. High resolution 'targetted' magnetic resonance imaging was used to scan the forefoot. Neuropathic patients with and without previous ulceration were matched for degree of neuropathy, mean vibration perception threshold 33.5 +/- 4.2 V (previous ulcer) vs 31.0 +/- 6.9 V (no ulcer), age, sex, and duration of diabetes against non-neuropathic controls. There were nine patients in each category. Paramagnetic materials, e.g. iron compounds, cause a signal void ('drop-out') on gradient-echo images which disappear on spin-echo images. Evidence of haemorrhage was seen in 6 patients with previous ulceration, and none in the other groups (p = 0.009, chi square test). Autologous injection of 20 microliters of blood into the foot of a healthy volunteer produced similar images, a 'drop-out' 1 cm across being visible on magnetic resonance scanning 3 days later. Peak vertical forefoot pressures were not significantly different in the neuropathic groups 0.67 +/- 0.20 vs 0.60 +/- 0.13 Pa but were lower in the non-neuropathic group, 0.43 +/- 0.11 Pa (p = 0.0004, Mann-Whitney), and do not explain the appearance of these haemorr...Continue Reading

Citations

Jun 1, 2006·Journal of Magnetic Resonance Imaging : JMRI·Sicco A BusRobert Lindeboom
Apr 5, 2008·Diabetes/metabolism Research and Reviews·Sicco A Bus
Jan 20, 2004·Journal of the American Podiatric Medical Association·Frag AbouaeshaAndrew J M Boulton
Jul 5, 2002·Archives of Physical Medicine and Rehabilitation·Carine H van SchieAndrew J Boulton

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