Nuclear Medicine and Diabetic Foot Infections

Palestro, Christopher J.; Love, Charito

doi:10.1053/j.semnuclmed.2008.08.006

Cited by 102 publications

(73 citation statements)

References 29 publications

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“…Infected foot ulcers in the diabetic patient comprise up to 90% of pedal osteomyelitis cases [33]. Devillers et al…”

Section: Resultsmentioning

confidence: 99%

“…It can also effectively detect the development of infection in anterior parts of the bone. However, its efficacy is dramatically compromised at the mid foot and hind foot [33,[37][38][39]. Despite its high sensitivity, MRI application for the recognition of osteomyelitis in the diabetic foot is compromised due to lower specificity related to Charcot neuropathic osteoarthropathy.…”

Section: Resultsmentioning

confidence: 99%

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

Assadi

Vahdat²,

Nabipour³

et al. 2011

Nuclear Medicine Communications

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Objective The discrimination of bacterial infections from sterile inflammatory processes is of great importance in the management of inflammation. Currently available techniques cannot decisively address this issue. In this respect, antimicrobial peptide 99m Tc-ubiquicidin (UBI) 29-41 scans have been showing interesting results. The aim of this study was to determine the accuracy of 99m Tc-UBI scan in the detection of osteomyelitis and to compare it with 99m Tc-methylene diphosphonate scan and magnetic resonance imaging (MRI).Methods Twenty patients (mean age = 48.90 years) with suspected osteomyelitis were included in this study. After evaluation of each patient through history taking, physical examination, appropriate laboratory tests, and other processes including bone probing, wound culture, and plain film radiography, MRIs, 99m Tc-UBI scans, and 99m Tc-methylene diphosphonate scans were performed. For quantitative analysis, the mean count of abnormal-tonormal (A/N) region was calculated for images acquired at 15, 30, 45, 60, 120, and 240 min to obtain the most favorable time for imaging. Results In total, osteomyelitis was detected in the 99mTc-UBI scans of 17 patients, indicating 100% accuracy, compared with an accuracy of 90% for osteomyelitis detected in three-phase bone scans. The maximum mean A/N was observed at 15 min after intravenous injection (median: 1.91; interquartile range: 1.54-2.94). MRI was performed in 12 cases only with 75% accuracy. In addition, the A/N ratios for the 99m Tc-UBI scans were not significantly different between patients with or without Staphylococcus aureus growth on wound cultures.Conclusion For fast imaging with high accuracy, 99m Tc-UBI 29-41 is a suitable choice for the detection of osteomyelitis.

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“…Infected foot ulcers in the diabetic patient comprise up to 90% of pedal osteomyelitis cases [33]. Devillers et al…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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

Assadi

Vahdat²,

Nabipour³

et al. 2011

Nuclear Medicine Communications

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“…However, this distinction may sometimes be difficult based on MRI alone. Labelled leukocyte scintigraphy is complementary to MRI in making this diagnosis and is a useful tool for follow up of the patients with osteomyelitis ( Figure 4) [4]. …”

Section: Imaging In Diabetic Footmentioning

confidence: 99%

“…Triple phase bone scintigraphy is sensitive however lacks anatomic details and specificity. Hence, often it is used as a screening test or complimentary to labelled leukocyte scintigraphy [3,4].…”

Section: Imaging In Diabetic Footmentioning

confidence: 99%

Imaging in Diabetic Foot

Dhanda¹,

Quek²

2017

J Arthritis

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“…Diabetic patients can have a significant foot infection without a systemic response, and the diagnosis of osteomyelitis often is overlooked (34). Labeled leukocyte imaging is the radionuclide gold standard for diagnosing diabetic 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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Nuclear Medicine and Diabetic Foot Infections

Cited by 102 publications

References 29 publications

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

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

Imaging in Diabetic Foot

Radionuclide Imaging of Musculoskeletal Infection: A Review

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