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Related Experiment Videos

The diabetic foot.

M B Tomas1, M Patel, S E Marwin

  • 1Division of Nuclear Medicine, Long Island Jewish Medical Center, New Hyde Park, New York 11040, USA.

The British Journal of Radiology
|June 9, 2000
PubMed
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Diagnosing diabetic foot osteomyelitis and Charcot joints is challenging. Advanced imaging like labeled leucocyte scintigraphy and MRI are crucial for accurate diagnosis and surgical guidance, with combined techniques showing promise.

Area of Science:

  • Orthopedics
  • Nuclear Medicine
  • Radiology

Background:

  • Diabetic foot complications, particularly ulceration, frequently lead to amputation.
  • Pedal osteomyelitis complicates over 90% of diabetic forefoot ulcers.
  • Neuropathic or Charcot joint is a principal complication in the mid and hind foot.

Purpose of the Study:

  • To review the diagnostic utility of various imaging modalities for diabetic foot osteomyelitis and neuropathic joints.
  • To compare the effectiveness of plain radiographs, bone scintigraphy, labeled leucocyte scintigraphy, and MRI.

Main Methods:

  • Review of imaging techniques including plain radiography, three-phase bone scintigraphy, labeled leucocyte scintigraphy, and MRI.
  • Discussion of the diagnostic challenges in differentiating osteomyelitis from neuropathic changes.

Related Experiment Videos

  • Exploration of combined leucocyte/marrow scintigraphy for infected Charcot joints.

    • Main Results:

    • Plain radiographs offer anatomical detail but lack sensitivity and specificity for osteomyelitis.
    • Three-phase bone scintigraphy is sensitive but not specific.
    • Labeled leucocyte scintigraphy and MRI are valuable and complementary; MRI provides superior anatomical detail for surgical planning.
    • Distinguishing neuropathic marrow edema from osteomyelitis is difficult with conventional methods.
    • Labeled leucocyte uptake can occur without infection due to active marrow.

    Conclusions:

    • Labeled leucocyte scintigraphy is valuable for diagnosing and monitoring pedal osteomyelitis.
    • MRI is invaluable for surgical guidance in osteomyelitis.
    • The role of MRI in evaluating infected Charcot joints is still uncertain.
    • Combined leucocyte/marrow scintigraphy shows promise for diagnosing infected neuropathic joints.