Current challenges in imaging of the diabetic foot

Abstract

Although a variety of diagnostic imaging modalities are available for the evaluation of diabetes-related foot complications, the distinction between neuroarthropathy and osteomyelitis is still challenging. The early and accurate diagnosis of diabetic foot complications can help reduce the incidence of infection-related morbidities, the need for and duration of hospitalization, and the incidence of major limb amputation. Conventional radiography, computed tomography, nuclear medicine scintigraphy, magnetic resonance imaging, ultrasonography, and positron emission tomography are the main procedures currently in use for the evaluation of diabetes-related foot complications. However, each of these modalities does not provide enough information alone and a multimodal approach should be used for an accurate diagnosis. The present study is a review of the current concepts in imaging of diabetes-related foot complications and an analysis of the advantages and disadvantages of each method.

Quantum dot-based diabetic foot mapping for diagnosing osteomyelitis and Charcot neuroarthropathy

“…99m TC and 111In-WBC do not accumulate at sites of new bone formation without infection [21]. MRI is the most sensitive modality in detecting early changes in CN, with 90-100% sensitivity and 40-100% specificity [21][22][23][24][25].…”

“…Technetium-99m methylene diphosphonate 99m (TC-MDP) is positive in all three stages of CN and reflects the increased turnover of bone [20,21]. 99m TC and 111In-WBC do not accumulate at sites of new bone formation without infection [21].…”

Management of Hospitalized Patients with Diabetic Foot Infections

“…However, each of these modalities has limitations and should be ordered and interpreted within the whole clinical context and after consultation with the appropriate services. [24][25][26][27][28] Cultures should be obtained, not to diagnose the infection, but rather to determine which organism is causing the infection, is the presence of nonreplicating bacteria on wound surface, and wound colonization is the presence of replicating bacteria without tissue injury or immune response. Critical colonization involves the replication of bacteria in the superficial wound base with tissue damage.…”

The Diabetic Foot: A Historical Overview and Gaps in Current Treatment

“…Therefore, plain radiography is mainly used for the evaluation of major structural changes. 26 MRI is currently considered as the best modality for the evaluation of soft tissue and bone marrow changes associated with the diabetic foot. 27 The sensitivity and specificity of MRI for the detection of osteomyelitis are high, making it useful as a diagnostic instrument.…”