Abstract
Sequential Tc-99m hydroxymethylene-diphosphonate (HDP) 3-phase bone (BS) and In-111
leukocyte scanning (WBCS) have been frequently used to evaluate the diabetic foot,
as nonosteomyelitis BS uptake is repeatedly observed and osteomyelitis (OM) in WBCS
is often uncertain without BS correlation. Additionally, both modalities are limited
in lesion localization because of low resolution and lack of anatomic details. We
investigated a method that combined BS/WBCS, and if needed, WBCS/bone marrow scanning
(BMS) using SPECT/CT to accurately diagnose/localize infection in a practical protocol.
Blood flow/pool images were obtained followed by WBC reinjection and next day dual
isotope (DI) BS/WBCS planar and SPECT/CT. BMS/WBCS SPECT/CT (step 2 DI) was obtained
on the following day when images were suspicious for mid/hindfoot OM. Diagnosis accuracy
and confidence were judged for the various imaging combinations. Diagnosis was classified
as OM, soft tissue infection (STI), both OM/STI, and other/no bony pathology by microbiology/pathology
or follow-up. Distinction between various diagnostic categories and overall OM diagnostic
accuracy in 213 patients were higher for DI than WBCS or BS alone, and for DI SPECT/CT
than DI planar or SPECT only. Diagnostic confidence/lesion site was significantly
higher for DI SPECT/CT than other comparative imaging methods. In a group of 97 patients
with confirmed microbiologic/pathologic diagnosis, similar results were attained.
Step 2 DI SPECT/CT performed in 67 patients further improved diagnostic accuracy/confidence.
DI SPECT/CT is a highly accurate modality that considerably improves detection and
discrimination of STI and OM while providing precise anatomic localization in the
diabetic foot. This combined imaging technique promises to beneficially impact diabetic
patient care.
Keywords
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Article info
Publication history
Published online: September 20, 2010
Footnotes
Financial Disclosure: None reported.
Conflict of Interest: None reported.
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© 2010 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.
