FDG PET and PET/CT Imaging in Complicated Diabetic Foot

This article reviews the published data on the utilization of [(18)F]Fluorodeoxyglucose (FDG) positron emission tomography (PET) and PET/CT imaging in patients with complicated diabetic foot. Three areas have been identified where FDG-PET/CT can have an important role in the clinical decision making process of this disease and could be helpful to the podiatricians if found accurate: (a) Diagnosis of deep soft tissue infection and osteomyelitis (OM), (b) differentiating Charcot arthropathy from OM and (c) evaluating the ischemia/atherogenesis component in a particular case. The main focus of the research initiatives involving PET in the setting of diabetic foot syndrome has been its possible role in the reliable diagnosis or exclusion of OM. The literature on the efficacy of FDG PET in reliably diagnosing or excluding OM in diabetic foot is divided with two groups of results; four studies emphasizing the potential usefulness and two depicting relatively low sensitivity of this modality. The combined PET/CT fusion approach appears better than FDG PET imaging alone owing to superior anatomical localization and thereby better differentiation of soft tissue infection and bone. With the establishment of clinically functioning PET/MRI units, it is essential to conduct further research studies designed to investigate the ability of this modality as the most optimal one-stop shop diagnostic imaging technique for the management of patients with diabetic foot. A relatively less explored area is the role of FDG PET in assessing atherosclerosis in the large vessels of the lower limb that could help in studying the ischemia component and its contribution in the development of diabetic foot. Further research is required in this direction.