Leukocyte Scanning With 111In Is Superior to Magnetic Resonance Imaging in Diagnosis of Clinically Unsuspected Osteomyelitis in Diabetic Foot Ulcers

Newman, Lisa G.; Waller, John; Palestro, Christopher J.; Hermann, George; Klein, Michael; Schwartz, Myron; Harrington, Elizabeth B.; Harrington, Michael; Roman, Sheila H.; Stagnaro-Green, Alex

doi:10.2337/diacare.15.11.1527

Cited by 71 publications

(35 citation statements)

References 5 publications

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“…False positive results have been reported in several conditions, including rapidly progressive neuroarthropathy. Due to the poor spatial resolution in indium-111 leukocyte studies, uptake in soft tissues could be incorrectly attributed to bone uptake and vice versa [15,21] . Bone imaging combined with labeled leukocyte imaging improves the diagnostic accuracy of foot osteomyelitis and its differentiation from the soft-tissue infection.…”

Section: Discussionmentioning

confidence: 99%

“…The radiological fi ndings are not reliable in establishing the diagnosis in patients with violated bone which will give nonspecifi c fi ndings, being diagnostic in only 3-5% of culture-positive cases. Conventional radiographs have proved to be neither sensitive nor specifi c for the diagnosis of osteomyelitis [13,15,16] .…”

Section: Discussionmentioning

confidence: 99%

“…Indium-111 leukocyte imaging has been reported to be both sensitive and specifi c for diabetic foot infections [21] . However, its sensitivity ranges from 50 to 100% and specifi cities from 29 to 100% [15,21] . False positive results have been reported in several conditions, including rapidly progressive neuroarthropathy.…”

Section: Discussionmentioning

confidence: 99%

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Evaluating Diabetic Foot Infection with Magnetic Resonance Imaging: Kuwait Experience

et al. 2005

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Objective: The aim of this study was to evaluate the capability of magnetic resonance imaging (MRI) to depict and characterize the changes seen in diabetic foot infections. Subjects and Methods: MRI studies of 29 diabetic patients with suspected foot infection were evaluated. Sagittal and transverse T₁-weighted images before and after intravenous gadolinium, and transverse fat-suppressed T₂-weighted images were performed on the affected regions. The MRI findings were compared to subsequent clinical and/or histopathological findings. Results: The MRI findings were: osteomyelitis in 14 patients, abscess in 5, cellulitis in 26, tenosynovitis in 4 and neuropathic joint in 8. Three cases were normal. Pathological confirmations were obtained in 19 patients. MRI and histological diagnosis were in concordance in 79% of osteomyelitis cases, 100% of neuropathy cases and 100% of cellulitis cases. The sensitivity and specificity of MRI in diagnosing osteomyelitis were 100 and 63%, respectively. The positive predictive and negative predictive values, and the accuracy were 79, 100 and 84%, respectively. MRI helped surgical planning for limb salvage procedures in 6 of the osteomyelitis cases and in a cellulitis case. Conclusion: The results indicate that MRI is a sensitive and accurate imaging modality for the evaluation of foot infections in diabetic patients and for planning proper treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Evaluating Diabetic Foot Infection with Magnetic Resonance Imaging: Kuwait Experience

et al. 2005

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“…Numerous studies have demonstrated that triple-phase 99 Tc-MDP (methylenediphosphonate) scans are of little value in differentiating these entities [36][37][38][39][40][41]. Although bone scanning is sensitive, especially for early infection, it is rather nonspecific, and so unsuitable for distinguishing between neuroosteoarthropathy and infection.…”

Section: Isotope Scanningmentioning

confidence: 99%

Is this bone infected or not? Differentiating neuro-osteoarthropathy from osteomyelitis in the diabetic foot

Berendt

Lipsky²

2004

Curr Diab Rep

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Osteomyelitis (bone infection) and neuro-osteoarthropathy (Charcot arthropathy) are limb-threatening complications of diabetic neuropathy with very different therapies. Distinguishing between them may be difficult, but it is important. In Charcot arthropathy, noninfectious soft tissue inflammation accompanies rapidly progressive destruction, first of joints, then of bone. This occurs in a well-vascularized and severely neuropathic, but nonulcerated, foot. In osteomyelitis, chronic soft tissue ulceration precedes infection of bone, which may be physically exposed. Magnetic resonance imaging and bone biopsy are the preferred diagnostic tests, provided adequate technical and interpretive skills are available.

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“…MRI has the obvious advantages of providing excellent anatomic detail and resolution of both bones and soft tissues. Labeled leukocyte imaging may be more sensitive for detecting clinically unsuspected pedal osteomyelitis and is useful for monitoring response to medical therapy, and evaluating the neuropathic joint (Newman et al, 1991;Newman et al, 1992;Palestro et al, 1998;Palestro and Tomas, 2000).…”

Section: Diabetic Foot Infectionsmentioning

confidence: 99%

Radionuclide imaging of musculoskeletal infection

Palestro

Love

2007

Braz. arch. biol. technol.

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Leukocyte Scanning With 111In Is Superior to Magnetic Resonance Imaging in Diagnosis of Clinically Unsuspected Osteomyelitis in Diabetic Foot Ulcers

Abstract: Leukocyte scanning is superior to MRI in detecting clinically unsuspected osteomyelitis in diabetic foot ulcers.

Cited by 71 publications

References 5 publications

Evaluating Diabetic Foot Infection with Magnetic Resonance Imaging: Kuwait Experience

Evaluating Diabetic Foot Infection with Magnetic Resonance Imaging: Kuwait Experience

Is this bone infected or not? Differentiating neuro-osteoarthropathy from osteomyelitis in the diabetic foot

Radionuclide imaging of musculoskeletal infection

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