Indexing Severity of Diabetic Foot Infection With 99mTc-WBC SPECT/CT Hybrid Imaging

Erdman, William A.; Buethe, Ji; Bhore, Rafia; Ghayee, Hans K.; Thompson, Chiarra; Maewal, Param; Anderson, J. A.; Klemow, Steve; Öz, Orhan K.

doi:10.2337/dc11-2425

Cited by 46 publications

(41 citation statements)

References 31 publications

(40 reference statements)

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“…after injection) is necessary because of the slow leukocyte accumulation in infected sites as compared with bone marrow. Regrettably, this delay between injection and imaging is not possible using 18 F as radiolabel, but fortunately, 64 Copper, with a half-life of 12.7 h, appears to be a more suitable radionuclide for labelling of white blood cells; the first attempts to in vitro labelling of WBCs with 64 Copper have been successful [76], and we are anxiously waiting for the first clinical results. 68 Ga-citrate PET/CT imaging is another emerging technology.…”

Section: Positron Emission Tomography/magnetic Resonance Imagingmentioning

confidence: 99%

Challenges in diagnosing infection in the diabetic foot

2015

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Diagnosing the presence of infection in the foot of a patient with diabetes can sometimes be a difficult task. Because open wounds are always colonized with microorganisms, most agree that infection should be diagnosed by the presence of systemic or local signs of inflammation. Determining whether or not infection is present in bone can be especially difficult. Diagnosis begins with a history and physical examination in which both classic and 'secondary' findings suggesting invasion of microorganisms or a host response are sought. Serological tests may be helpful, especially measurement of the erythrocyte sedimentation rate in osteomyelitis, but all (including bone biomarkers and procalcitonin) are relatively non-specific. Cultures of properly obtained soft tissue and bone specimens can diagnose and define the causative pathogens in diabetic foot infections. Newer molecular microbial techniques, which may not only identify more organisms but also virulence factors and antibiotic resistance, look very promising. Imaging tests generally begin with plain X-rays; when these are inconclusive or when more detail of bone or soft tissue abnormalities is required, more advanced studies are needed. Among these, magnetic resonance imaging is generally superior to standard radionuclide studies, but newer hybrid imaging techniques (single-photon emission computed tomography/computed tomography, positron emission tomography/computed tomography and positron emission tomography/magnetic resonance imaging) look to be useful techniques, and new radiopharmaceuticals are on the horizon. In some cases, ultrasonography, photographic and thermographic methods may also be diagnostically useful. Improved methods developed and tested over the past decade have clearly increased our accuracy in diagnosing diabetic foot infections.

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Section: Positron Emission Tomography/magnetic Resonance Imagingmentioning

confidence: 99%

Challenges in diagnosing infection in the diabetic foot

2015

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“…The sensitivity and specificity of 99m Tc-HMPAO-WBC range from 86 to 93 % and from 80 to 98 %, respectively. SPECT/CT improves test accuracy [12][13][14][15] (Fig. 2).…”

Section: Labeled Leukocytesmentioning

confidence: 97%

Multiagent imaging of inflammation and infection with radionuclides

Palestro

Glaudemans

Dierckx

2013

Clin Transl Imaging

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Molecular imaging with single photon-and positron-emitting tracers plays an important role in the evaluation of inflammation and infection. Although supplanted by labeled leukocyte imaging for most indications, gallium-67 remains useful for opportunistic infections, pulmonary inflammation and interstitial nephritis and, when [ 18 F]FDG is not available, spinal infection and fever of unknown origin. In vitro labeled leukocyte imaging is the radionuclide procedure of choice for most infections in immunocompetent patients. When performed for musculoskeletal infection, complementary bone marrow imaging usually is necessary. Recent data suggest that dual time point imaging might be an alternative to marrow imaging. Several methods of labeling leukocytes in vivo, with agents including antigranulocyte antibodies and antibody fragments, peptides and cytokines, have been investigated, with variable results. These agents are not widely available and none of them are available in the USA. Radiolabeled antibiotics have been investigated as ''infection-specific'' tracers, but the results to date have been disappointing. Conversely, radiolabeled antimicrobial peptides do hold promise as infection-specific tracers. The use of positronemitting tracers for diagnosing inflammation and infection has generated considerable interest. [ 18 F]FDG is useful in fever of unknown origin, spinal osteomyelitis, vasculitis and sarcoidosis. Other positron-emitting tracers that have been investigated include [ 18 F]FDG-labeled leukocytes, copper-64-labeled leukocytes, gallium-68 citrate and iodine-124 FIAU. Although radiolabeled tracers are used primarily for diagnosis, they also offer objective biomarkers for assessing response to therapeutic interventions in inflammatory diseases. They could also potentially be used to target cells and molecules with specific receptor expression for histological characterization, select patients for receptor-targeted therapy and predict response to treatment.

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“…In addition, negative WBC SPECT/CT was demonstrated to represent a good marker for diagnosis of diabetic foot osteomyelitis remission and could therefore be very useful in guiding antibiotic therapy [61]. The integration of WBC SPECT/CT findings into a recently proposed new Composite Severity Index was found to be of prognostic value in a preliminary study [62]. WBC SPECT/CT acquisition improves diagnostic accuracy, at least for the mid and hind foot, whereas its role in evaluation of the forefoot is still a matter of debate.…”

Section: Footmentioning

confidence: 99%

SPECT/CT in infection and inflammation

Erba

Israel²

2014

Clin Transl Imaging

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Nuclear medicine procedures are part of the evaluation armamentarium used in patients with suspected or confirmed infection. The strength of functional imaging modalities rests on their being non-invasive tests that provide pathophysiological information early in the course of disease. Their limitations, related to a somewhat low specificity of radiotracers and image resolution, have largely been overcome over the last 15Â years following the introduction of the hybrid SPECT/CT technology. SPECT/CT is redefining the diagnostic workup of patients with suspected or known infectious and inflammatory processes involving the musculoskeletal system as well as those with infectious and inflammatory disease located in various soft-tissue sites. Furthermore, it has been shown that in addition to improving diagnostic accuracy (by adding specificity to the inherent high sensitivity of single-photon emission tomography), SPECT/CT leads to changes in the subsequent clinical management of patients. The main indications for SPECT/CT in infection, as well as updated literature data on this topic, are presented in the following review

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Indexing Severity of Diabetic Foot Infection With 99mTc-WBC SPECT/CT Hybrid Imaging

Cited by 46 publications

References 31 publications

Challenges in diagnosing infection in the diabetic foot

Challenges in diagnosing infection in the diabetic foot

Multiagent imaging of inflammation and infection with radionuclides

SPECT/CT in infection and inflammation

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