Abstract
Diabetic foot infections (DFIs) represent one of the most frequent and disabling morbidities of longstanding diabetes; therefore, early diagnosis is mandatory. The aim of this multicenter retrospective study was to compare the diagnostic accuracy of white blood cell scintigraphy (WBC), 18F-fluorodeoxyglucose positron emission tomography/computed tomography ((18F) FDG PET/CT), and Magnetic Resonance Imaging (MRI) in patients with suspected DFI. Images and clinical data from 251 patients enrolled by five centers were collected in order to calculate the sensitivity, specificity, and accuracy of WBC, FDG, and MRI in diagnosing osteomyelitis (OM), soft-tissue infection (STI), and Charcot osteoarthropathy. In OM, WBC acquired following the European Society of Nuclear Medicine (EANM) guidelines was more specific and accurate than MRI (91.9% vs. 70.7%, p < 0.0001 and 86.2% vs. 67.1%, p = 0.003, respectively). In STI, both FDG and WBC achieved a significantly higher specificity than MRI (97.9% and 95.7% vs. 83.6%, p = 0.04 and p = 0.018, respectively). In Charcot, both MRI and WBC demonstrated a significantly higher specificity and accuracy than FDG (88.2% and 89.3% vs. 62.5%, p = 0.0009; 80.3% and 87.9% vs. 62.1%, p < 0.02, respectively). Moreover, in Charcot, WBC was more specific than MRI (89.3% vs. 88.2% p < 0.0001). Given the limitations of a retrospective study, WBC using EANM guidelines was shown to be the most reliable imaging modality to differentiate between OM, STI, and Charcot in patients with suspected DFI.
Highlights
Diabetes-related foot complications represent some of the most frequent and disabling morbidities of longstanding diabetes and are associated with prolonged hospitalization and high social costs [1,2,3,4,5]
Since we did not observe any statistically significant difference between the three imaging modalities in therapy decision-making, we can conclude that they have similar accuracy in guiding clinicians for the correct management of patients affected by OM or soft tissue infection (STI). This retrospective multicenter study is, to the best of our knowledge, the first to compare the diagnostic value of white blood cell scintigraphy (WBC) scintigraphy, FDG positron emission tomography combined with computed tomography (PET/CT), and Magnetic Resonance Imaging (MRI) in a large population of patients with suspected Diabetic foot infections (DFIs), with a particular emphasis on the ability of these imaging modalities to differentiate between OM, STI, and Charcot
On the other hand, comparing the results of WBC scintigraphy acquired according to European Society of Nuclear Medicine (EANM) guidelines with FDG PET/CT and MRI, we found that the WBC scan was more accurate and specific than MRI in OM, more specific than MRI in STI, and more specific and accurate than FDG in Charcot
Summary
Diabetes-related foot complications represent some of the most frequent and disabling morbidities of longstanding diabetes and are associated with prolonged hospitalization and high social costs [1,2,3,4,5]. Osteomyelitis (OM) is a severe complication for the diabetic patient, with a high risk of amputation and mortality rates [6,7,8]. About 2.5% of diabetic patients have a Charcot foot, a progressive degenerative disease of the musculoskeletal system characterized by destruction of the bony architecture, which usually involves tarsal and metatarsal joints [11]. The presence of this neuro-ostearthropathy further complicates the diagnostic approach to diabetic foot infection (DFI) since this condition may coexist with the presence of ulcers, making the correct diagnosis difficult to achieve. A differential diagnosis between Charcot, OM, and soft tissue infection (STI) is crucial for the correct management in patients suspected of DFI
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
