Imaging of Lower Extremity Artery Atherosclerosis in Diabetic Foot

Abstract

In this communication, we present the FDG-PET findings in 2 patients with Type II diabetes mellitus with foot complications. The first case was a 47-year-old female patient, diagnosed case of a diabetic foot with ischemic complications and the second was a 60-year-old female patient diagnosed to have a neuropathic Charcot foot. Although the first case demonstrated prominent diffuse uptake in the lower extremity arteries, including popliteal and tibial arteries, the other did not. Histopathological correlation was available in both cases: the case showing diffuse FDG uptake in the arteries revealed features of atherosclerosis along with evidence of a gangrenous right toe; the other case without any uptake in the arteries had no evidence of atherosclerosis in the pathologic examination. However, increased tracer uptake was noted in the distal left tibia just above the ankle, midshaft of the tibia as well as in the soft tissue of lateral and plantar aspect of the left foot which was suggestive of osteomyelitis and cellulites, respectively, consequent to the neuropathy. FDG-PET is being actively investigated for its potential to image atherosclerosis. The present report describes its application for assessing inflammation related to atherosclerosis in a diabetic foot with ischemic complications and has important implications for clinical management because making a distinction between diabetic neuropathy and angiopathy is critical for therapeutic intervention in these patients. It is worthwhile to consider a larger prospective trial on the role of FDG-PET in this setting.