Noninvasive technique using thallium-201 for predicting ischaemic ulcer healing of the foot

A post-stress imaging study utilizing single intravenous doses of thallium-201 was performed on feet with trophic skin lesions. Forty-two ischaemic ulcers were classified into four basic types according to the presence and degree of the inherent inflammatory response of the ulcer in both the initial and delayed distributions. Both the relationship between ulcer type and prognosis and the effects of therapy within ulcer type were assessed. The results suggest that ulcers of Type I or Type II heal in response to conservative treatment, while ulcers of Type III, although undergoing healing, require surgical treatment to prevent a protracted hospitalization. In Type IV ulcers, healing is not to be expected at all with conservative therapy; therefore an early decision of amputation may be necessary if surgical measures are not indicated. The technique reported may be helpful not only in the prediction of spontaneous ulcer healing but also in the selection of appropriate treatment.