Utility of PET/CT with fluorine-18-fluorodeoxyglucose-labeled autologous leukocytes for diagnosing diabetic foot osteomyelitis in patients with Charcot’s neuroarthropathy

Rastogi, Ashu; Bhattacharya, Anish; Prakash, Mahesh; Sharma, Sarika; Mittal, Bhagwant Rai; Khandelwal, Niranjan; Bhansali, Anil

doi:10.1097/mnm.0000000000000603

Cited by 53 publications

(47 citation statements)

References 20 publications

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“…The presence of osteomyelitis, documented in six studies, ranged from 10‐54% (average approximately 30%) of the enrolled cases. One prospective study not included in this analysis also found that for diagnosing osteomyelitis in patients with Charcot neuroarthropathy, 18 F‐FDG‐labelled leukocyte PET/CT had the same sensitivity (83.3%) as contrast to enhanced MRI, but its specificity was 100%, compared with 63.6%. One small prospective study of low quality found that diffusion‐weighted MRI for the diagnosis of diabetic foot osteomyelitis had low performance characteristics (sensitivity 64.6% and accuracy 63.7%).…”

Section: Resultsmentioning

confidence: 92%

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Diagnosis of infection in the foot in diabetes: a systematic review

Senneville

Lipsky

Abbas

et al. 2020

Diabetes Metabolism Res

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Background Securing an early accurate diagnosis of diabetic foot infections and assessment of their severity are of paramount importance since these infections can cause great morbidity and potentially mortality and present formidable challenges in surgical and antimicrobial treatment. Methods In June 2018, we searched the literature using PuEbMed and EMBASE for published studies on the diagnosis of diabetic foot infection. On the basis of predetermined criteria, we reviewed prospective controlled, as well as noncontrolled, studies in any language, seeking translations for those not in English. We then developed evidence statements on the basis of the included papers. Results From the 4242 records screened, we selected 35 papers that met our inclusion criteria. The quality of all but one of the evidence statements was low because of the weak methodology of nearly all of the studies. The available data suggest that diagnosing diabetic foot infections on the basis of clinical signs and symptoms and classified according to the International Working Group of the Diabetic Foot scheme correlates with the patient's likelihood of ulcer healing, of lower extremity amputation, and risk of death. Elevated levels of selected serum inflammatory markers are supportive, but not diagnostic, of soft tissue or bone infection. In patients with suspected diabetic foot osteomyelitis, both a positive probe‐to‐bone test and an elevated erythrocyte sedimentation rate are strongly associated with its presence. Culturing tissue samples of soft tissues or bone, when care is taken to avoid contamination, provides more accurate microbiological information than culturing superficial (swab) samples. Plain X‐ray remains the first‐line imaging examination when there is suspicion of diabetic foot osteomyelitis, but advanced imaging methods help in cases when either the diagnosis or the localization of infection is uncertain. Conclusion The results of this first reported systematic review on the diagnosis of diabetic foot infections provide some guidance for clinicians, but there is a need for more prospective controlled studies of high quality.

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Section: Resultsmentioning

confidence: 92%

“…References: Lauri et al, Ertugrul et al, Johnson et al, Nawaz et al, Newman et als, Shagos et al, Blume et al, Treglia et al, Rastogi et al, Abdel Razek and Samir, Aslangul et al, and Poirier et al…”

Section: Resultsmentioning

confidence: 99%

Diagnosis of infection in the foot in diabetes: a systematic review

Senneville

Lipsky

Abbas

et al. 2020

Diabetes Metabolism Res

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“…It could be proposed that WBC-SPECT/CT be performed at 6 weeks of treatment in a subset of individuals (for example, those with a persistent wound, probe-to-bone test, soft-tissue inflammation and/or elevated inflammatory marker), but this approach needs to be confirmed in studies. It is also of note that, in addition to WBC-SPECT/CT, other recent nuclear imaging techniques appear to be promising for the diagnosis and management of DFO, though none is currently validated to predict DFO remission [27][28][29][30][31].…”

Section: Discussionmentioning

confidence: 99%

Application of white blood cell SPECT/CT to predict remission after a 6 or 12 week course of antibiotic treatment for diabetic foot osteomyelitis

et al. 2017

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Aims/hypothesis Diabetic foot osteomyelitis is a major risk factor for amputation. Medical treatment allows remission in 53-82% of cases. However, the optimal duration of antibiotic therapy remains controversial as a validated marker of osteomyelitis remission is lacking. The aim of this cohort study was to assess prospectively the remission rate of diabetic foot osteomyelitis medically treated using white blood cell (WBC)-single-photon emission computed tomography (SPECT)/computed tomography (CT) as a predictive marker of remission. Methods Individuals with diabetic foot osteomyelitis that was non-surgically treated between April 2014 and December 2015 were included. All participants were treated with antibiotics alone. WBC-SPECT/CT was performed at 6 weeks and antibiotic treatment discontinued if the clinical signs of soft-tissue infection had resolved and there was no abnormal uptake of labelled WBCs. Treatment was otherwise continued for a total of 12 weeks and then discontinued. For these individuals, another WBC-SPECT/CT was performed at 12 weeks. Remission was defined as the absence of recurrence of osteomyelitis at the same location at 1 year. Results Forty-five individuals were included; overall remission rate was 84% at 1 year. A 6 week course of antibiotics was used in 23 participants, 22 of whom were in remission at 1 year (96%); a 12 week course was used for 22 participants, 16 of whom were in remission at 1 year (73%). Sensitivity of WBC-SPECT/CT at 12 weeks was 100%, specificity 56%, positive predictive value 46% and negative predictive value 100%. Conclusions/interpretation The study suggests that WBC-SPECT/CT could predict remission at the end of antibiotic treatment.

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“…In selected patients with possible neuro‐osteoarthropathy, newer techniques such as MR angiography, dynamic contrast‐enhanced MRI or neurography may better distinguish Charcot from osteomyelitis . Newer advanced imaging tests, especially 18 F‐fluorodeoxyglucose (FDG)‐PET/CT and 99m Tc‐exametazime (HMPAO)‐labelled leukocyte scintigraphy, can be used in patients with a contraindication to MRI and appear to have a higher specificity than MRI (especially when noninfectious bony changes are more likely) but are limited in availability, require special expertise, and are more expensive . Compared with other nuclear medicine techniques (eg, leukocyte imaging), PET (especially with CT) offers high spatial resolution and precise anatomic localization, possibly higher sensitivity for chronic infection, easier performance, faster results, and low radiation exposure.…”

Section: Diagnosismentioning

confidence: 99%

Guidelines on the diagnosis and treatment of foot infection in persons with diabetes (IWGDF 2019 update)

Lipsky

Senneville

Abbas

et al. 2020

Diabetes Metabolism Res

520

729

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The International Working Group on the Diabetic Foot (IWGDF) has published evidence‐based guidelines on the prevention and management of diabetic foot disease since 1999. This guideline is on the diagnosis and treatment of foot infection in persons with diabetes and updates the 2015 IWGDF infection guideline. On the basis of patient, intervention, comparison, outcomes (PICOs) developed by the infection committee, in conjunction with internal and external reviewers and consultants, and on systematic reviews the committee conducted on the diagnosis of infection (new) and treatment of infection (updated from 2015), we offer 27 recommendations. These cover various aspects of diagnosing soft tissue and bone infection, including the classification scheme for diagnosing infection and its severity. Of note, we have updated this scheme for the first time since we developed it 15 years ago. We also review the microbiology of diabetic foot infections, including how to collect samples and to process them to identify causative pathogens. Finally, we discuss the approach to treating diabetic foot infections, including selecting appropriate empiric and definitive antimicrobial therapy for soft tissue and for bone infections, when and how to approach surgical treatment, and which adjunctive treatments we think are or are not useful for the infectious aspects of diabetic foot problems. For this version of the guideline, we also updated four tables and one figure from the 2016 guideline. We think that following the principles of diagnosing and treating diabetic foot infections outlined in this guideline can help clinicians to provide better care for these patients.

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Utility of PET/CT with fluorine-18-fluorodeoxyglucose-labeled autologous leukocytes for diagnosing diabetic foot osteomyelitis in patients with Charcot’s neuroarthropathy

Abstract: F-FDG-LL PET/CT has high specificity for the diagnosis of DFO in complicated diabetic foot. The F-fluoride PET/CT helps in the characterization the extent of underlying CN. An early and accurate diagnosis with F-FDG-LL PET/CT aids the rational initiation of antibiotics for DFO.

Cited by 53 publications

References 20 publications

Diagnosis of infection in the foot in diabetes: a systematic review

Diagnosis of infection in the foot in diabetes: a systematic review

Application of white blood cell SPECT/CT to predict remission after a 6 or 12 week course of antibiotic treatment for diabetic foot osteomyelitis

Guidelines on the diagnosis and treatment of foot infection in persons with diabetes (IWGDF 2019 update)

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