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18-F flourodeoxy glucose positron emission tomography-computed tomography imaging: A viable alternative to three phase bone scan in evaluating diabetic foot complications?

Shagos GS, Shanmugasundaram P, Varma AK, Padma S, Sarma M - Indian J Nucl Med (2015 Apr-Jun)

Bottom Line: Interpretation was based on intensity, extent, pattern of MDP and FDG uptake (standardized uptake value) along with CT correlation.Findings were compared with final diagnostic outcome based on bone/soft tissue culture in Group I and clinical, radiological or scintigraphic followup in Group II.Flourodeoxy glucose PET-CT has a higher specificity and NPV than TPBS in diagnosing pedal osteomyelitis.

View Article: PubMed Central - PubMed

Affiliation: Department of Nuclear Medicine and PET-CT, Amrita Institute of Medical Sciences, Kochi, Kerala, India.

ABSTRACT

Background: This paper is based on the initial findings from a prospective ongoing study to evaluate the efficacy of flourodeoxy glucose positron emission tomography-computed tomography (FDG-PET CT) in diabetic foot evaluation.

Objective: The aim was to compare the diagnostic accuracies of three phase bone scan (TPBS) and FDG PET-CT (FDG-PET) in diabetic foot evaluation.

Methods: Seventy-nine patients with complicated diabetic foot (osteomyelitis/cellulitis, Charcot's neuropathy) were prospectively investigated. TPBS (15 mci methylene di phosphonate [MDP] intravenous [IV]), followed by FDG-PET (5 mci IV) within 5 days were performed in all patients. Based on referral indication, patients grouped into Group I, n = 36, (?osteomyelitis/cellulitis) and Group II, n = 43 (?Charcot's neuropathy). Interpretation was based on intensity, extent, pattern of MDP and FDG uptake (standardized uptake value) along with CT correlation. Findings were compared with final diagnostic outcome based on bone/soft tissue culture in Group I and clinical, radiological or scintigraphic followup in Group II.

Results: Group I: For diagnosing osteomyelitis, TP: TN: FP: FN were 14:5:2:2 by FDG PET and 13:02:05:03 by TPBS respectively. Sensitivity, specificity, positive predictive value and negative predictive value (NPV) of FDG-PET were 87.5%, 71%, 87.5% and 71% and 81.25%, 28.5%, 72% and 40% for TPBS, respectively. Group II: charcot's: cellulitis: Normal were 22:14:7 by FDG PET and 32:5:6 by TPBS, respectively.

Conclusion: Flourodeoxy glucose PET-CT has a higher specificity and NPV than TPBS in diagnosing pedal osteomyelitis. TPBS, being highly sensitive is more useful than FDG-PET in detecting Charcot's neuropathy.

No MeSH data available.


Related in: MedlinePlus

(a) Vascular phase images showing increased vascularity in left heel region and Figure 1 (b) Soft tissue and skeletal phase images showing diffuse increased methylene di phosphonate (MDP) uptake in the left calcaneum in three phase MDP bone scan of a suspected case of left calcaneal osteomyelitis
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Figure 6: (a) Vascular phase images showing increased vascularity in left heel region and Figure 1 (b) Soft tissue and skeletal phase images showing diffuse increased methylene di phosphonate (MDP) uptake in the left calcaneum in three phase MDP bone scan of a suspected case of left calcaneal osteomyelitis

Mentions: The study Group I comprised of patients with nonhealing ulcers who were on medical management for a while and in whom even after a clinical or radiological examination, the physician could not exclude or conclusively establish underlying osteomyelitis. By TPBS alone, being a highly sensitive imaging modality, 27 patients were reported to be diagnostic of osteomyelitis as against 19 patients by FDG PET-CT. So 8 patients who were labeled as osteomyelitis in TPBS were found to be showing diffuse FDG uptake confined more to the surrounding soft tissues than in the involved bone, thereby ruling out osteomyelitis in them [Figures 6a, b and Figure 7a-c]. The co-registration of PET and CT images was found to be extremely useful in accurately pinpointing the involved bones as well as in differentiating bony uptake from the surrounding soft tissue uptake [Figures 8a, b and Figure 9a-c].


18-F flourodeoxy glucose positron emission tomography-computed tomography imaging: A viable alternative to three phase bone scan in evaluating diabetic foot complications?

Shagos GS, Shanmugasundaram P, Varma AK, Padma S, Sarma M - Indian J Nucl Med (2015 Apr-Jun)

(a) Vascular phase images showing increased vascularity in left heel region and Figure 1 (b) Soft tissue and skeletal phase images showing diffuse increased methylene di phosphonate (MDP) uptake in the left calcaneum in three phase MDP bone scan of a suspected case of left calcaneal osteomyelitis
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4379691&req=5

Figure 6: (a) Vascular phase images showing increased vascularity in left heel region and Figure 1 (b) Soft tissue and skeletal phase images showing diffuse increased methylene di phosphonate (MDP) uptake in the left calcaneum in three phase MDP bone scan of a suspected case of left calcaneal osteomyelitis
Mentions: The study Group I comprised of patients with nonhealing ulcers who were on medical management for a while and in whom even after a clinical or radiological examination, the physician could not exclude or conclusively establish underlying osteomyelitis. By TPBS alone, being a highly sensitive imaging modality, 27 patients were reported to be diagnostic of osteomyelitis as against 19 patients by FDG PET-CT. So 8 patients who were labeled as osteomyelitis in TPBS were found to be showing diffuse FDG uptake confined more to the surrounding soft tissues than in the involved bone, thereby ruling out osteomyelitis in them [Figures 6a, b and Figure 7a-c]. The co-registration of PET and CT images was found to be extremely useful in accurately pinpointing the involved bones as well as in differentiating bony uptake from the surrounding soft tissue uptake [Figures 8a, b and Figure 9a-c].

Bottom Line: Interpretation was based on intensity, extent, pattern of MDP and FDG uptake (standardized uptake value) along with CT correlation.Findings were compared with final diagnostic outcome based on bone/soft tissue culture in Group I and clinical, radiological or scintigraphic followup in Group II.Flourodeoxy glucose PET-CT has a higher specificity and NPV than TPBS in diagnosing pedal osteomyelitis.

View Article: PubMed Central - PubMed

Affiliation: Department of Nuclear Medicine and PET-CT, Amrita Institute of Medical Sciences, Kochi, Kerala, India.

ABSTRACT

Background: This paper is based on the initial findings from a prospective ongoing study to evaluate the efficacy of flourodeoxy glucose positron emission tomography-computed tomography (FDG-PET CT) in diabetic foot evaluation.

Objective: The aim was to compare the diagnostic accuracies of three phase bone scan (TPBS) and FDG PET-CT (FDG-PET) in diabetic foot evaluation.

Methods: Seventy-nine patients with complicated diabetic foot (osteomyelitis/cellulitis, Charcot's neuropathy) were prospectively investigated. TPBS (15 mci methylene di phosphonate [MDP] intravenous [IV]), followed by FDG-PET (5 mci IV) within 5 days were performed in all patients. Based on referral indication, patients grouped into Group I, n = 36, (?osteomyelitis/cellulitis) and Group II, n = 43 (?Charcot's neuropathy). Interpretation was based on intensity, extent, pattern of MDP and FDG uptake (standardized uptake value) along with CT correlation. Findings were compared with final diagnostic outcome based on bone/soft tissue culture in Group I and clinical, radiological or scintigraphic followup in Group II.

Results: Group I: For diagnosing osteomyelitis, TP: TN: FP: FN were 14:5:2:2 by FDG PET and 13:02:05:03 by TPBS respectively. Sensitivity, specificity, positive predictive value and negative predictive value (NPV) of FDG-PET were 87.5%, 71%, 87.5% and 71% and 81.25%, 28.5%, 72% and 40% for TPBS, respectively. Group II: charcot's: cellulitis: Normal were 22:14:7 by FDG PET and 32:5:6 by TPBS, respectively.

Conclusion: Flourodeoxy glucose PET-CT has a higher specificity and NPV than TPBS in diagnosing pedal osteomyelitis. TPBS, being highly sensitive is more useful than FDG-PET in detecting Charcot's neuropathy.

No MeSH data available.


Related in: MedlinePlus