FDG PET/CT imaging in the diagnosis of osteomyelitis in the diabetic foot

Kagna, Olga; Srour, Saher; Melamed, Eyal; Militianu, Daniela; Keidar, Zohar

doi:10.1007/s00259-012-2183-z

Cited by 72 publications

(35 citation statements)

References 22 publications

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“…Regrettably, this delay between injection and imaging is not possible using 18 F as radiolabel, but fortunately, 64 Copper, with a half-life of 12.7 h, appears to be a more suitable radionuclide for labelling of white blood cells; the first attempts to in vitro labelling of WBCs with 64 Copper have been successful [76], and we are anxiously waiting for the first clinical results. 68 Ga-citrate PET/CT imaging is another emerging technology. The imaging characteristics of the PET tracer 68 Ga are superior to those of 67 Ga because it provides higher spatial resolution and because of the quantification potential of PET.…”

Section: Positron Emission Tomography/magnetic Resonance Imagingmentioning

confidence: 99%

Challenges in diagnosing infection in the diabetic foot

2015

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Diagnosing the presence of infection in the foot of a patient with diabetes can sometimes be a difficult task. Because open wounds are always colonized with microorganisms, most agree that infection should be diagnosed by the presence of systemic or local signs of inflammation. Determining whether or not infection is present in bone can be especially difficult. Diagnosis begins with a history and physical examination in which both classic and 'secondary' findings suggesting invasion of microorganisms or a host response are sought. Serological tests may be helpful, especially measurement of the erythrocyte sedimentation rate in osteomyelitis, but all (including bone biomarkers and procalcitonin) are relatively non-specific. Cultures of properly obtained soft tissue and bone specimens can diagnose and define the causative pathogens in diabetic foot infections. Newer molecular microbial techniques, which may not only identify more organisms but also virulence factors and antibiotic resistance, look very promising. Imaging tests generally begin with plain X-rays; when these are inconclusive or when more detail of bone or soft tissue abnormalities is required, more advanced studies are needed. Among these, magnetic resonance imaging is generally superior to standard radionuclide studies, but newer hybrid imaging techniques (single-photon emission computed tomography/computed tomography, positron emission tomography/computed tomography and positron emission tomography/magnetic resonance imaging) look to be useful techniques, and new radiopharmaceuticals are on the horizon. In some cases, ultrasonography, photographic and thermographic methods may also be diagnostically useful. Improved methods developed and tested over the past decade have clearly increased our accuracy in diagnosing diabetic foot infections.

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Section: Positron Emission Tomography/magnetic Resonance Imagingmentioning

confidence: 99%

Challenges in diagnosing infection in the diabetic foot

2015

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“…In these patients, bone scan and indium scanning has been used, but there is new interest in PET/CT. Studies have shown improved sensitivity and specificity of PET/CT over bone scan and indium scanning[11] and has been found to have excellent performance in the identification of osteomyelitis within the complicated diabetic foot [12]. The PEM images of patient 1 clearly show the activity within the cuboidal bone and improve upon the PET/CT images by showing more moderate activity in the adjacent distal calcaneus.…”

Section: Discussionmentioning

confidence: 99%

Is imaging the extremities with PEM feasible? A novel application for a high-resolution positron emission scanner

et al. 2014

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“…Nawaz et al (47) reported that 18 F-FDG PET was 81% accurate for pedal osteomyelitis. Kagna et al (49) reported that 18 F-FDG PET/CT was 96% accurate for pedal osteomyelitis.…”

Section: Diabetic Pedal Osteomyelitismentioning

confidence: 99%

Radionuclide Imaging of Musculoskeletal Infection: A Review

Palestro

2016

J Nucl Med

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Learning Objectives: On successful completion of this activity, participants should be able to describe (1) the principle of combined labeled leukocyte/marrow imaging; (2) at least one advantage of 18 F-FDG PET or PET/CT over MRI for diagnosing spondylodiskitis; and (3) at least one advantage of SPECT/CT over planar imaging in the diagnosis of pedal osteomyelitis in diabetic patients.Financial Disclosure: The author of this article has indicated no relevant relationships that could be perceived as a real or apparent conflict of interest. CME Credit: SNMMI is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing education for physicians. SNMMI designates each JNM continuing education article for a maximum of 2.0 AMA PRA Category 1 Credits. Physicians should claim only credit commensurate with the extent of their participation in the activity. For CE credit, SAM, and other credit types, participants can access this activity through the SNMMI website (http://www.snmmilearningcenter.org) through September 2019.There are numerous imaging tests for diagnosing musculoskeletal infection. Radiographs are routinely performed, because even when not diagnostic, they provide an anatomic overview of the region of interest that could influence subsequent procedure selection and interpretation. MRI is sensitive and provides superb anatomic detail. Bone scintigraphy accurately diagnoses osteomyelitis in bones not affected by underlying conditions. 67 Ga is used primarily for spondylodiskitis. Although in vitro labeled leukocyte imaging is the radionuclide test of choice for complicating osteomyelitis such as diabetic pedal osteomyelitis and prosthetic joint infection, it is not useful for spondylodiskitis. Antigranulocyte antibodies and antibody fragments have limitations and are not widely available. 111 In-biotin is useful for spondylodiskitis. Radiolabeled synthetic fragments of the antimicrobial peptide ubiquicidin are promising infection-specific agents. 18 F-FDG is the radiopharmaceutical of choice for spondylodiskitis. Its role in diabetic pedal osteomyelitis and prosthetic joint infection is not established. Preliminary data suggest 68 Ga may be useful in musculoskeletal infection. 124 I-fialuridine initially showed promise as an infection-specific radiopharmaceutical, but subsequent investigations were disappointing. The development of PET/CT and SPECT/CT imaging systems, which combine anatomic and functional imaging, has revolutionized diagnostic imaging. These hybrid systems are redefining the diagnostic workup of patients with suspected or known infection and inflammation by improving diagnostic accuracy and influencing patient management.

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FDG PET/CT imaging in the diagnosis of osteomyelitis in the diabetic foot

Cited by 72 publications

References 22 publications

Challenges in diagnosing infection in the diabetic foot

Challenges in diagnosing infection in the diabetic foot

Is imaging the extremities with PEM feasible? A novel application for a high-resolution positron emission scanner

Radionuclide Imaging of Musculoskeletal Infection: A Review

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