PURPOSE: Osteomyelitis, the most serious complication of the diabetic foot, occurs in about 20 % of patients. Early diagnosis is crucial. Appropriate treatment will avoid or decrease the likelihood of amputation. The objective of this study was to assess the value of FDG PET/CT in diabetic patients with clinically suspected osteomyelitis. METHODS: Enrolled in this prospective study were 39 consecutive diabetic patients (29 men and 10 women, mean age 57 years, range 28-71 years) with 46 suspected sites of foot infection. Of these 39 patients, 38 had type 2 and 1 type 1 diabetes for 4-25 years, and 28 were receiving treatment with insulin. FDG PET/CT was interpreted for the presence, intensity (SUVmax) and localization of increased FDG foci. Final diagnosis was based on histopathology and bacteriology of surgical samples, or clinical and imaging follow-up. RESULTS: Osteomyelitis was correctly diagnosed in 18 and excluded in 21 sites. Of 20 lesions with focal bone FDG uptake, 2 were false-positive with no further evidence of osteomyelitis. Five sites of diffuse FDG uptake involving more than one bone on CT were correctly diagnosed as diabetic osteoarthropathy. FDG PET/CT had a sensitivity, specificity and accuracy of 100 %, 92 % and 95 % in a patient-based analysis and 100 %, 93 % and 96 % in a lesion-based analysis, respectively, for the diagnosis of osteomyelitis in the diabetic foot. CONCLUSION: FDG PET/CT was found to have high performance indices for evaluation of the diabetic foot. The PET component identified FDG-avid foci in sites of acute infection which were precisely localized on fused PET/CT images allowing correct differentiation between osteomyelitis and soft-tissue infection.
PURPOSE:Osteomyelitis, the most serious complication of the diabetic foot, occurs in about 20 % of patients. Early diagnosis is crucial. Appropriate treatment will avoid or decrease the likelihood of amputation. The objective of this study was to assess the value of FDG PET/CT in diabeticpatients with clinically suspected osteomyelitis. METHODS: Enrolled in this prospective study were 39 consecutive diabeticpatients (29 men and 10 women, mean age 57 years, range 28-71 years) with 46 suspected sites of foot infection. Of these 39 patients, 38 had type 2 and 1 type 1 diabetes for 4-25 years, and 28 were receiving treatment with insulin. FDG PET/CT was interpreted for the presence, intensity (SUVmax) and localization of increased FDG foci. Final diagnosis was based on histopathology and bacteriology of surgical samples, or clinical and imaging follow-up. RESULTS:Osteomyelitis was correctly diagnosed in 18 and excluded in 21 sites. Of 20 lesions with focal bone FDG uptake, 2 were false-positive with no further evidence of osteomyelitis. Five sites of diffuse FDG uptake involving more than one bone on CT were correctly diagnosed as diabetic osteoarthropathy. FDG PET/CT had a sensitivity, specificity and accuracy of 100 %, 92 % and 95 % in a patient-based analysis and 100 %, 93 % and 96 % in a lesion-based analysis, respectively, for the diagnosis of osteomyelitis in the diabetic foot. CONCLUSION: FDG PET/CT was found to have high performance indices for evaluation of the diabetic foot. The PET component identified FDG-avid foci in sites of acute infection which were precisely localized on fused PET/CT images allowing correct differentiation between osteomyelitis and soft-tissue infection.
Authors: Chantal P Bleeker-Rovers; Elisabeth M H A de Kleijn; Frans H M Corstens; Jos W M van der Meer; Wim J G Oyen Journal: Eur J Nucl Med Mol Imaging Date: 2003-10-10 Impact factor: 9.236
Authors: Demetrio Familiari; Andor W J M Glaudemans; Valeria Vitale; Daniela Prosperi; Oreste Bagni; Andrea Lenza; Marco Cavallini; Francesco Scopinaro; Alberto Signore Journal: J Nucl Med Date: 2011-06-16 Impact factor: 10.057
Authors: B T Lipman; B D Collier; G F Carrera; M E Timins; S J Erickson; J E Johnson; J R Mitchell; R G Hoffmann; W A Finger; A Z Krasnow; R S Hellman Journal: Clin Nucl Med Date: 1998-02 Impact factor: 7.794
Authors: H M Zhuang; A Cortés-Blanco; M Pourdehnad; L E Adam; A J Yamamoto; R Martínez-Lázaro; J H Lee; J C Loman; M D Rossman; A Alavi Journal: Nucl Med Commun Date: 2001-10 Impact factor: 1.690
Authors: B Schwegler; K D M Stumpe; D Weishaupt; K Strobel; G A Spinas; G K von Schulthess; J Hodler; T Böni; M Y Donath Journal: J Intern Med Date: 2007-11-23 Impact factor: 8.989
Authors: Abhijit J Chaudhari; William Y Raynor; Ali Gholamrezanezhad; Thomas J Werner; Chamith S Rajapakse; Abass Alavi Journal: PET Clin Date: 2021-01