{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T22:09:09Z","timestamp":1785190149795,"version":"3.55.0"},"reference-count":20,"publisher":"American Diabetes Association","issue":"9","license":[{"start":{"date-parts":[[2023,7,12]],"date-time":"2023-07-12T00:00:00Z","timestamp":1689120000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.diabetesjournals.org\/journals\/pages\/license"}],"funder":[{"DOI":"10.13039\/501100000361","name":"Diabetes UK","doi-asserted-by":"publisher","award":["RD08\/0003729"],"award-info":[{"award-number":["RD08\/0003729"]}],"id":[{"id":"10.13039\/501100000361","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["diabetesjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,9,1]]},"abstract":"<jats:sec><jats:title>OBJECTIVE<\/jats:title><jats:p>To compare X-ray and MRI as diagnostic tests of active Charcot neuro-osteoarthropathy (CNO) in diabetes.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESEARCH DESIGN AND METHODS<\/jats:title><jats:p>X-rays and MRI scans of 48 participants were rated for severity of fracture (0 = no fracture, 1 = fracture, 2 = collapse\/fragmentation), and for absence\/presence of bone marrow edema (BME) on MRI and absence\/presence of bone injury on X-ray. The agreement between modalities was assessed with tests for symmetry, marginal homogeneity, and \u03ba-coefficients.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>X-ray underscored MRI in grading fractures in the metatarsals (P = 0.05) and tarsals (P &amp;lt; 0.001) and reported as normal 79% of the bones with BME. The agreement between X-ray and MRI for grading severity of fracture was moderate to substantial (\u03ba = 0.53; P &amp;lt; 0.001) and for detecting bone injury, slight to fair (\u03ba = 0.17; P &amp;lt; 0.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>The significant underperformance of X-ray in the assessment of the hot, swollen foot in diabetes should be considered when confirming or refuting the diagnosis of active CNO.<\/jats:p><\/jats:sec>","DOI":"10.2337\/dc23-0220","type":"journal-article","created":{"date-parts":[[2023,7,12]],"date-time":"2023-07-12T21:19:14Z","timestamp":1689196754000},"page":"1668-1672","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":2,"title":["Grading Fractures on Foot and Ankle X-rays and MRI Scans in the Active Charcot Foot in Diabetes: How Strong Is the Agreement Between Modalities?"],"prefix":"10.2337","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5708-1281","authenticated-orcid":false,"given":"Oliver","family":"Artz","sequence":"first","affiliation":[{"name":"1Diabetic Foot Clinic, King\u2019s College Hospital NHS Foundation Trust, London, U.K."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Meacock","sequence":"additional","affiliation":[{"name":"2Department of Clinical Radiology, King\u2019s College Hospital NHS Foundation Trust, London, U.K."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David A.","family":"Elias","sequence":"additional","affiliation":[{"name":"2Department of Clinical Radiology, King\u2019s College Hospital NHS Foundation Trust, London, U.K."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8931-0069","authenticated-orcid":false,"given":"Michael E.","family":"Edmonds","sequence":"additional","affiliation":[{"name":"1Diabetic Foot Clinic, King\u2019s College Hospital NHS Foundation Trust, London, U.K."},{"name":"3Diabetes and Obesity, School of Cardiovascular and Metabolic Medicine and Sciences, Faculty of Life Sciences and Medicine, King\u2019s College London, London, U.K."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6937-6565","authenticated-orcid":false,"given":"Nina L.","family":"Petrova","sequence":"additional","affiliation":[{"name":"1Diabetic Foot Clinic, King\u2019s College Hospital NHS Foundation Trust, London, U.K."},{"name":"3Diabetes and Obesity, School of Cardiovascular and Metabolic Medicine and Sciences, Faculty of Life Sciences and Medicine, King\u2019s College London, London, 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