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

Shagos, G S; Palaniswamy, Shanmugasundaram; Varma, Ajith Kumar; Subramanyam, Padma; Sarma, Manjit

doi:10.4103/0972-3919.152946

Cited by 20 publications

(15 citation statements)

References 9 publications

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“…While the pooled sensitivity of all the different imaging modalities were comparable (89‐93%), the specificity of MRI (75%, 63‐84%) and 111 In‐oxine WBC scintigraphy (75%, 66‐82%) were considerably lower than 99m Tc‐HMPAO WBC scintigraphy (92%, 78‐98%) and 18 F‐FDG‐PET/CT (92%, 85‐96). Five studies identified in our search were included in this meta‐analysis. We found one small, prospective preliminary study that was not included in the meta‐analysis that reported similar results for 99m Tc‐HMPAO WBC imaging in diagnosing diabetic foot osteomyelitis (sensitivity 90% and specificity 86%).…”

Section: Resultsmentioning

confidence: 99%

“…References: Lauri et al, Ertugrul et al, Johnson et al, Nawaz et al, Newman et als, Shagos et al, Blume et al, Treglia et al, Rastogi et al, Abdel Razek and Samir, Aslangul et al, and Poirier et al…”

Section: Resultsmentioning

confidence: 99%

“…While the pooled sensitivity of all the different imaging modalities were comparable (89-93%), the specificity of MRI (75%, 63-84%) and 111 In-oxine WBC scintigraphy (75%, 66-82%) were considerably lower than 99m Tc-HMPAO WBC scintigraphy (92%, 78-98%) and 18 F-FDG-PET/CT (92%, 85-96). Five studies [35][36][37][38][39] identified in our search were included in this meta-analysis.…”

Section: 4mentioning

confidence: 99%

“…References: Lam et al, 25 Lavery et al, 26 Mutluoglu et al, 27 Zaiton et al, 28 Fleischer et al, 29 References: Lauri et al, 34 Ertugrul et al, 35 Johnson et al, 36 Nawaz et al, 37 Newman et als, 38 Shagos et al, 39 Blume et al, 40 Treglia et al, 41 Rastogi et al, 42 Abdel Razek and Samir, 43 Aslangul et al, 44 and 9% of the cases. The authors established that the overall accuracy swabs in these settings was 73%.…”

Section: 4mentioning

confidence: 99%

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Diagnosis of infection in the foot in diabetes: a systematic review

Senneville

Lipsky

Abbas

et al. 2020

Diabetes Metabolism Res

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Background Securing an early accurate diagnosis of diabetic foot infections and assessment of their severity are of paramount importance since these infections can cause great morbidity and potentially mortality and present formidable challenges in surgical and antimicrobial treatment. Methods In June 2018, we searched the literature using PuEbMed and EMBASE for published studies on the diagnosis of diabetic foot infection. On the basis of predetermined criteria, we reviewed prospective controlled, as well as noncontrolled, studies in any language, seeking translations for those not in English. We then developed evidence statements on the basis of the included papers. Results From the 4242 records screened, we selected 35 papers that met our inclusion criteria. The quality of all but one of the evidence statements was low because of the weak methodology of nearly all of the studies. The available data suggest that diagnosing diabetic foot infections on the basis of clinical signs and symptoms and classified according to the International Working Group of the Diabetic Foot scheme correlates with the patient's likelihood of ulcer healing, of lower extremity amputation, and risk of death. Elevated levels of selected serum inflammatory markers are supportive, but not diagnostic, of soft tissue or bone infection. In patients with suspected diabetic foot osteomyelitis, both a positive probe‐to‐bone test and an elevated erythrocyte sedimentation rate are strongly associated with its presence. Culturing tissue samples of soft tissues or bone, when care is taken to avoid contamination, provides more accurate microbiological information than culturing superficial (swab) samples. Plain X‐ray remains the first‐line imaging examination when there is suspicion of diabetic foot osteomyelitis, but advanced imaging methods help in cases when either the diagnosis or the localization of infection is uncertain. Conclusion The results of this first reported systematic review on the diagnosis of diabetic foot infections provide some guidance for clinicians, but there is a need for more prospective controlled studies of high quality.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: 4mentioning

confidence: 99%

Section: 4mentioning

confidence: 99%

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Diagnosis of infection in the foot in diabetes: a systematic review

Senneville

Lipsky

Abbas

et al. 2020

Diabetes Metabolism Res

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“…Shagos et al (51) reported that 18 F-FDG PET was more specific than bone scintigraphy for osteomyelitis, whereas bone scintigraphy was more sensitive than 18 F-FDG PET for the neuropathic joint. Schwegler et al (52).…”

Section: Diabetic Pedal Osteomyelitismentioning

confidence: 99%

Radionuclide Imaging of Musculoskeletal Infection: A Review

Palestro

2016

J Nucl Med

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Learning Objectives: On successful completion of this activity, participants should be able to describe (1) the principle of combined labeled leukocyte/marrow imaging; (2) at least one advantage of 18 F-FDG PET or PET/CT over MRI for diagnosing spondylodiskitis; and (3) at least one advantage of SPECT/CT over planar imaging in the diagnosis of pedal osteomyelitis in diabetic patients.Financial Disclosure: The author of this article has indicated no relevant relationships that could be perceived as a real or apparent conflict of interest. CME Credit: SNMMI is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing education for physicians. SNMMI designates each JNM continuing education article for a maximum of 2.0 AMA PRA Category 1 Credits. Physicians should claim only credit commensurate with the extent of their participation in the activity. For CE credit, SAM, and other credit types, participants can access this activity through the SNMMI website (http://www.snmmilearningcenter.org) through September 2019.There are numerous imaging tests for diagnosing musculoskeletal infection. Radiographs are routinely performed, because even when not diagnostic, they provide an anatomic overview of the region of interest that could influence subsequent procedure selection and interpretation. MRI is sensitive and provides superb anatomic detail. Bone scintigraphy accurately diagnoses osteomyelitis in bones not affected by underlying conditions. 67 Ga is used primarily for spondylodiskitis. Although in vitro labeled leukocyte imaging is the radionuclide test of choice for complicating osteomyelitis such as diabetic pedal osteomyelitis and prosthetic joint infection, it is not useful for spondylodiskitis. Antigranulocyte antibodies and antibody fragments have limitations and are not widely available. 111 In-biotin is useful for spondylodiskitis. Radiolabeled synthetic fragments of the antimicrobial peptide ubiquicidin are promising infection-specific agents. 18 F-FDG is the radiopharmaceutical of choice for spondylodiskitis. Its role in diabetic pedal osteomyelitis and prosthetic joint infection is not established. Preliminary data suggest 68 Ga may be useful in musculoskeletal infection. 124 I-fialuridine initially showed promise as an infection-specific radiopharmaceutical, but subsequent investigations were disappointing. The development of PET/CT and SPECT/CT imaging systems, which combine anatomic and functional imaging, has revolutionized diagnostic imaging. These hybrid systems are redefining the diagnostic workup of patients with suspected or known infection and inflammation by improving diagnostic accuracy and influencing patient management.

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Diagnosis of infection in the foot of patients with diabetes: A systematic review

Senneville,

Albalawi,

van Asten

et al. 2023

Diabetes Metabolism Res

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BackgroundSecuring an early accurate diagnosis of diabetic foot infections and assessment of their severity are of paramount importance since these infections can cause great morbidity and potential mortality and present formidable challenges in surgical and antimicrobial treatment.MethodsIn June 2022, we searched the literature using PubMed and EMBASE for published studies on the diagnosis of diabetic foot infection (DFI). On the basis of pre‐determined criteria, we reviewed prospective controlled, as well as non‐controlled, studies in English. We then developed evidence statements based on the included papers.ResultsWe selected a total of 64 papers that met our inclusion criteria. The certainty of the majority of the evidence statements was low because of the weak methodology of nearly all of the studies. The available data suggest that diagnosing diabetic foot infections on the basis of clinical signs and symptoms and classified according to the International Working Group of the Diabetic Foot/Infectious Diseases Society of America scheme correlates with the patient's likelihood of the need for hospitalisation, lower extremity amputation, and risk of death. Elevated levels of selected serum inflammatory markers such as erythrocyte sedimentation rate (ESR), C‐reactive protein and procalcitonin are supportive, but not diagnostic, of soft tissue infection. Culturing tissue samples of soft tissues or bone, when care is taken to avoid contamination, provides more accurate microbiological information than culturing superficial (swab) samples. Although non‐culture techniques, especially next‐generation sequencing, are likely to identify more bacteria from tissue samples including bone than standard cultures, no studies have established a significant impact on the management of patients with DFIs. In patients with suspected diabetic foot osteomyelitis, the combination of a positive probe‐to‐bone test and elevated ESR supports this diagnosis. Plain X‐ray remains the first‐line imaging examination when there is suspicion of diabetic foot osteomyelitis (DFO), but advanced imaging methods including magnetic resonance imaging (MRI) and nuclear imaging when MRI is not feasible help in cases when either the diagnosis or the localisation of infection is uncertain. Intra‐operative or non‐per‐wound percutaneous biopsy is the best method to accurately identify bone pathogens in case of a suspicion of a DFO. Bedside percutaneous biopsies are effective and safe and are an option to obtain bone culture data when conventional (i.e. surgical or radiological) procedures are not feasible.ConclusionsThe results of this systematic review of the diagnosis of diabetic foot infections provide some guidance for clinicians, but there is still a need for more prospective controlled studies of high quality.

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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?

Cited by 20 publications

References 9 publications

Diagnosis of infection in the foot in diabetes: a systematic review

Diagnosis of infection in the foot in diabetes: a systematic review

Radionuclide Imaging of Musculoskeletal Infection: A Review

Diagnosis of infection in the foot of patients with diabetes: A systematic review

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