The term ulcer refers to a break in the skin, epithelium, or mucous membrane resulting in discontinuity of the surface tissues, necrosis, and often pus formation 1.
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Risk factors
immunocompromise (e.g. diabetes mellitus) 1
poor perfusion (e.g. peripheral vascular disease) 1,2
immobile patients 1,2
advanced age 2
poor nutrition 2
increased moisture 2
skin infection 1,2
Radiographic features
MRI
MRI can evaluate the extent of the spread of soft tissue infection and assess for osseous or articular extension 1. It can also be used to optimize surgical planning by mapping the extent of ulcer and soft tissue infection, leading to targeted 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 the ulcerated area.
Radiology report
The radiology report should contain a description of the following:
presence, location, and size of the ulcer
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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 any shallow ulcers because they can be challenging to localize on imaging 1
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