An ulcer refers to the break in the skin, epithelium, or mucous membrane resulting in the discontinuity in the surface tissue, necrosis, and often pus formation 1.
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Risk factors
- immunocompromised (e.g. diabetics) 1
- immobile patients 1,2
- advanced age 2
- poor nutrition 2
- increased moisture 2
- poor perfusion 1,2
- skin infection 1,2
Radiographic features
MRI
MRI can evaluate the extent of the spread of soft tissue infection and access the osseous or articular extension 1. It can also be used to optimize surgical planning by mapping the extent of ulcer and soft tissue infection, thereby reducing resection 3.
MRI appearance of an ulcer can be a focal skin/soft tissue defect with raised margins. Ulcer granulation tissues typically demonstrate 1:
- T2/T2FS: hyperintense
- T1 C+: marked peripheral enhancement
Eschar should be recognized as non-enhancing tissue overlying ulcerated area.
Radiology report
The radiology report should contain a description of the following:
- presence, location, and size of the ulcer
- any associated findings 1
- extent of the soft tissue infection
- osseous involvement
- extension into the joint
Practical points
- field of view should be centered on the region of interest 1
- a marker should be placed adjacent to the shallow ulcers because they can be challenging to localize on imaging 1
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