Diagnosis of Osteomyelitis in Neuropathic Foot Ulcers

Crerand, S.; Dolan, Marion; Laing, Peter; Bird, Michelle; Mj, Smith; Klenerman, L.

doi:10.1302/0301-620x.78b1.0780051

Cited by 39 publications

(16 citation statements)

References 18 publications

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“…Although some have yielded promising results in early studies, none has yet emerged as a robust and useful test for general application [45][46][47][48][49][50].…”

Section: Scintigraphymentioning

confidence: 99%

Diagnosing and treating diabetic foot infections

Lipsky

Berendt

Embil

et al. 2004

Diabetes Metab. Res. Rev.

112

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Foot infections are a common, complex and costly complication of diabetes. We have made considerable progress in establishing consensus definitions for defining infection. Similarly, we have learned much about the appropriate ways to diagnose both soft tissue and bone infections. Accompanying these advances have been improvements in our knowledge of the proper approaches to antibiotic (and surgical) therapy for diabetic foot infections. Furthermore, investigators have explored the value of various adjunctive therapies, especially granulocyte colony stimulating factors and hyperbaric oxygen, for improving outcomes. This paper presents a summary of a minisymposium on infection of the diabetic foot that was held at the fourth International Symposium on the Diabetic Foot, in Noordwijkerhout, The Netherlands.

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“…Although some have yielded promising results in early studies, none has yet emerged as a robust and useful test for general application [45][46][47][48][49][50].…”

Section: Scintigraphymentioning

confidence: 99%

Diagnosing and treating diabetic foot infections

Lipsky

Berendt

Embil

et al. 2004

Diabetes Metab. Res. Rev.

112

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“…are indicated [2 -6]. If infection is limited to soft tissues, oral antibiotics and short-course therapy may be sufficient [7,8].…”

mentioning

confidence: 99%

Clinical Articles Use of Sulesomab, a Radiolabeled Antibody Fragment, to Detect Osteomyelitis in Diabetic Patients with Foot Ulcers by Leukoscintigraphy

Harwood

Valdivia²,

Hung³

et al. 1999

CLIN INFECT DIS

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Diabetic patients suspected of having osteomyelitis secondary to foot ulcers underwent scintigraphic imaging with Sulesomab, an anti-granulocyte antibody Fab' fragment labeled with technetium-99m. Among 122 patients who had osteomyelitis confirmed or excluded by histopathologic and/or microbiologic techniques, Sulesomab had a 91% sensitivity, a 56% specificity, and an accuracy of 80%. One planar imaging session was usually sufficient for diagnosis, typically requiring 20-30 minutes of camera time 1-2 hours after injection. Compared with ex vivo autologous white blood cell (WBC) scans, Sulesomab performed comparably but with significantly greater sensitivity (92% vs. 79%; P < .05). Sulesomab results were more sensitive than radiography (90% vs. 62%; P < .05) and more specific than bone scans (50% vs. 21%; P < .05) and would have altered management plans in most patients. No related adverse events occurred, and there was no induction of human anti-mouse antibody. Sulesomab is an effective and rapid imaging agent that is diagnostically comparable or superior to WBC scans in this setting, with significant advantages in safety and ease of use.

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“…Bone imaging combined with labeled leukocyte imaging improves the diagnostic accuracy of foot osteomyelitis and its differentiation from the soft-tissue infection. Crerand et al [22] reported a sensitivity of 93% and a specifi city of 83% for this dual isotope technique.…”

Section: Discussionmentioning

confidence: 94%

Evaluating Diabetic Foot Infection with Magnetic Resonance Imaging: Kuwait Experience

et al. 2005

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Objective: The aim of this study was to evaluate the capability of magnetic resonance imaging (MRI) to depict and characterize the changes seen in diabetic foot infections. Subjects and Methods: MRI studies of 29 diabetic patients with suspected foot infection were evaluated. Sagittal and transverse T₁-weighted images before and after intravenous gadolinium, and transverse fat-suppressed T₂-weighted images were performed on the affected regions. The MRI findings were compared to subsequent clinical and/or histopathological findings. Results: The MRI findings were: osteomyelitis in 14 patients, abscess in 5, cellulitis in 26, tenosynovitis in 4 and neuropathic joint in 8. Three cases were normal. Pathological confirmations were obtained in 19 patients. MRI and histological diagnosis were in concordance in 79% of osteomyelitis cases, 100% of neuropathy cases and 100% of cellulitis cases. The sensitivity and specificity of MRI in diagnosing osteomyelitis were 100 and 63%, respectively. The positive predictive and negative predictive values, and the accuracy were 79, 100 and 84%, respectively. MRI helped surgical planning for limb salvage procedures in 6 of the osteomyelitis cases and in a cellulitis case. Conclusion: The results indicate that MRI is a sensitive and accurate imaging modality for the evaluation of foot infections in diabetic patients and for planning proper treatment.

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Diagnosis of Osteomyelitis in Neuropathic Foot Ulcers

Cited by 39 publications

References 18 publications

Diagnosing and treating diabetic foot infections

Diagnosing and treating diabetic foot infections

Clinical Articles Use of Sulesomab, a Radiolabeled Antibody Fragment, to Detect Osteomyelitis in Diabetic Patients with Foot Ulcers by Leukoscintigraphy

Evaluating Diabetic Foot Infection with Magnetic Resonance Imaging: Kuwait Experience

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