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Imaging osteomyelitis and the diabetic foot.
1Department of Nuclear Medicine, University of Göttingen, Germany.
The Quarterly Journal of Nuclear Medicine : Official Publication of the Italian Association of Nuclear Medicine (AIMN) [And] the International Association of Radiopharmacology (IAR)
|May 7, 1999
Summary
Diagnosing osteomyelitis and diabetic foot infections requires imaging. Plain radiography is the initial step, followed by bone scintigraphy or advanced imaging like CT/MRI for definitive diagnosis and to prevent complications.
Area of Science:
- Medical imaging
- Radiology
- Nuclear medicine
Background:
- Clinical diagnosis of osteomyelitis and diabetic foot infections often necessitates bone imaging.
- Early, reliable, and cost-effective diagnosis is crucial to prevent severe complications.
Purpose of the Study:
- To review and compare various radiological and nuclear medicine imaging methods for diagnosing osteomyelitis and diabetic foot infections.
- To establish an optimal imaging cascade for suspected osteomyelitis and diabetic foot cases.
Main Methods:
- Review of conventional radiography, tomography, computed tomography (CT), and magnetic resonance imaging (MRI).
- Evaluation of nuclear medicine techniques including bone scan, white blood cell scintigraphy (using 111In-oxin or 99mTc-HMPAO), antigranulocyte antibodies, 99mTc-/111In-human immunoglobulin, 67Ga-citrate, and 99mTc-nanocolloids.
Main Results:
- Radiological methods provide detailed pathological information.
- Nuclear medicine methods are effective for assessing specificity, such as detecting leukocytic infiltration.
Conclusions:
- For suspected osteomyelitis, the recommended imaging sequence is plain radiography, followed by three-phase bone scintigraphy, and then infection-specific radiopharmaceuticals.
- CT or MRI are considered for negative initial imaging with high clinical suspicion.
- For diabetic foot infections, the cascade starts with plain radiography, followed by three-phase bone scintigraphy or MRI, with nuclear medicine imaging for clinically evident neuropathy.