Proton magnetic resonance spectroscopy in the evaluation of patients with acute Charcot neuro-osteoarthropathy

To evaluate whether bone marrow proton magnetic resonance spectroscopy (MRS) might provide a quantitative parameter able to assess disease activity in acute Charcot neuro-osteoarthropathy (CN). Ten diabetic patients with stage 0 CN were prospectively evaluated at clinical onset and during treatment follow-up. The MRS lipid spectrum was analysed and a lipid polyunsaturation index (PUI) was calculated. Disease recovery was defined as the disappearance of bone marrow oedema as demonstrated on MRI short-tau-inversion-recovery (STIR) images. A 3-T MRI was used. Inter- and intra-individual PUI measurements generated reproducible results with approximately 7 % and 6 % variation respectively. Baseline PUI values were significantly higher in patients with acute CN compared with controls. Also, a significant positive correlation was observed between baseline PUI values and serum levels of IL-6 and TNF-alpha. During follow-up a gradual decrease in PUI was observed. The percentage reduction of PUI values at 3 months' follow-up with respect to baseline values showed a negative correlation with recovery time. Bone marrow MRS may provide a measurable index that allows progressive evaluation of disease activity in acute CN. MRS may be a complementary tool that can be used to guide clinicians in the management of acute CN patients. aEuro cent Bone marrow MRS demonstrates lipid alterations in acute Charcot neuro-osteoarthropathy (CN). aEuro cent Bone marrow MRS allows disease activity in acute CN to be evaluated. aEuro cent MRS could become a new tool in the management of CN.