Assessing diabetic foot osteomyelitis remission with white blood cell SPECT/CT imaging

Area of Science:

• Nuclear medicine
• Infectious diseases
• Orthopedics

Background:

• Diabetic foot osteomyelitis is a significant risk factor for lower limb amputation.
• Antibiotic therapy is crucial for managing osteomyelitis, but determining treatment duration is challenging without a reliable remission marker.
• Accurate diagnosis of osteomyelitis remission is essential to guide antibiotic therapy and prevent relapse.

Purpose of the Study:

• To evaluate the diagnostic performance of white blood cell SPECT/CT imaging in assessing diabetic foot osteomyelitis remission.
• To determine if white blood cell SPECT/CT can serve as a marker for osteomyelitis remission after antibiotic therapy.

Main Methods:

• A retrospective study included 29 episodes of diabetic foot osteomyelitis treated with antibiotics alone.
• Patients underwent radiographs, three-phase bone scintigraphy, and white blood cell SPECT/CT at the end of antibiotic therapy.
• Osteomyelitis remission was defined by the absence of relapse after 12 months of follow-up.

Main Results:

• White blood cell SPECT/CT demonstrated high diagnostic accuracy, with 100% sensitivity and 91.5% specificity for predicting relapse.
• A negative white blood cell SPECT/CT scan correctly identified all patients in remission (100% negative predictive value).
• In contrast, radiographs and three-phase bone scintigraphy showed lower specificity and predictive values.

Conclusions:

• Negative uptake on white blood cell SPECT/CT is a reliable indicator of diabetic foot osteomyelitis remission.
• White blood cell SPECT/CT imaging is a valuable tool for guiding the duration of antibiotic therapy in diabetic foot osteomyelitis.
• This imaging modality can aid in clinical decision-making to prevent lower limb amputations.