2005 Symposium on Advanced Wound Care | |
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Clinical Research
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High resolution (B-Mode) ultrasounography for detection of osteomyelitis in chronic wound patients: a pilot study with correlations to x-ray and MRI Martin E. Wendelken, DPM, RN, BioVisual Technologies, LLC, Elmwood, NJ; Christopher Comfort, MD, Lee Markowitz, DPM, Oscar M. Alvarez, PhD, Center for Palliative Wound Care, Calvary Hospital, Bronx, NY Fifteen consecutive chronic wound patients with clinical suspicion of bone infection were scanned with a high-resolution ultrasound device (Aloka SSD-900, Aloka Inc, Wallingford, CT) equipped with a 40mm 10-MHz linear array transducer. Wounds were filled with an acoustic amorphous gel, covered with a thin polyurethane film and scanned to obtain both cross-sectional and longitudinal views . This technique provides a clear illustration of the wounds and surrounding tissues up to a depth of 6 cm. A patient was given a positive diagnosis for osteomyelitis if the ultasound scan revealed erosion of the periosteum. Following the ultrsound scan, each patient also had an MRI and an X-Ray. Blinded results of each method were compared. In our limited experience there was a 100% correlation in the detection of ostemyelitis with HRUS and MRI. In a previous study comparing HRUS to MRI, Enderle et al., demonstrated that MRI was the most superior noninvasive imaging method for the diagnosis of osteomyelitis (100% sensitivity, 75% specificity). However, high resolution ultrasound (79% sensitivity and 80% specificity) can be performed by the general practitioner, has a similar sensitivity and specificity as bone scans and is time/cost effective without exposure to radiation. HRUS could be useful as a screening test to detect osteomyelitis, but further studies are needed to correlate this rapidly progressing technology to leukocyte bone scans and histopathology. References Wendelken, ME, Markowitz, L, Patel M, Alvarez, OM: Objective, Noninvasive, Wound Assessment using B-Mode Ultrasonography WOUNDS. 2003;15(11):351-360 Enderle MD, Coerper S, Schweizer HP, et al:Correlation of imaging techniques to histopathology in patients with diabetic foot syndrome and clinical suspicion of chronoc osteomyelitis. Diabetes Care. 1999;22(2):294–300 |
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