Diagnostic Performance of FDG-PET, MRI, and Plain Film Radiography (PFR) for the Diagnosis of Osteomyelitis in the Diabetic Foot

Abstract

FDG-PET is a highly specific imaging modality for the diagnosis of osteomyelitis in diabetic foot and, therefore, should be considered to be a useful complimentary imaging modality with MRI. In the setting where MRI is contraindicated, the high sensitivity and specificity of FDG-PET justifies its use after a negative or inconclusive PFR to aid an accurate diagnosis.

Can Sequential18F-FDG PET/CT Replace WBC Imaging in the Diabetic Foot?

“…18 F-FDG accumulates in inflammatory cells because these, like malignant cells, metabolize glucose as a source of energy (16). With the routine 18 F-FDG PET protocols, it is not possible to reliably distinguish infection from inflammation.…”

“…With the routine 18 F-FDG PET protocols, it is not possible to reliably distinguish infection from inflammation. No acquisition protocols for 18 F-FDG PET in the diabetic foot have yet been validated, and only a few comparison studies between 18 F-FDG PET and WBC scintigraphy are available.…”

“…To meet this aim, we compared this protocol with WBC scintigraphy for diagnostic accuracy. Another aim was to investigate possible interpretation criteria-both qualitative and quantitative-for WBC scintigraphy and for 18 F-FDG PET/CT to see which criteria are best able to differentiate between osteomyelitis, soft-tissue infection, and no infection at all.…”

Diagnostic value of 99mTc-ubiquicidin scintigraphy for osteomyelitis and comparisons with 99mTc-methylene diphosphonate scintigraphy and magnetic resonance imaging

“…MRI soundly assessed osteomyelitis in 20 of 22 patients and properly excluded it in 56 of 72 patients, with sensitivity, specificity, PPV, NPV, and accuracy of 91, 78, 56, 97, and 81%, respectively. PFR also had sensitivity, specificity, PPV, NPV, and accuracy of 63, 87, 60, 88, and 81%, respectively [28].…”

“…There are conflicting results regarding radiolabeled ciprofloxacin against microorganisms responsible for infection [24,25]. Although positron emission tomography (PET)-computed tomography using 18 F-fluorodeoxyglucose (FDG) may be promising for imaging bone infections [26][27][28], the impact of elevated serum glucose levels, present mainly in diabetic patients, on PET sensitivity is a controversial issue [29]. In addition, its high charge and limited accessibility hinder its widespread use in the detection of osteomyelitis.…”