<sup>18</sup>F-FDG and Diabetic Foot Infections: The Verdict Is…

Palestro, Christopher J.

doi:10.2967/jnumed.111.087478

Cited by 25 publications

(14 citation statements)

References 15 publications

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“…33 Hybridization of PET with MRI (PET/MRI) is emerging as a new tool to provide important diagnostic information. PET/CT has a significant advantage given its superior resolution to bone and labeled leukocyte imaging.…”

Section: Nuclear Medicinementioning

confidence: 99%

Imaging the Diabetic Foot

Konin

Morrison

2011

Techniques in Orthopaedics

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Pedal infection is a common sequela of diabetes with many underlying complications related to the nature of the systemic disease, ultimately confounding accurate and expeditious diagnosis. Although the imaging manifestations of diabetic pedal infection can at times be challenging due to underlying complications, including neuropathic arthropathy and vascular disease, imaging often yields accurate diagnoses. Magnetic resonance imaging is the modality of choice in evaluating diabetic pedal infection and knowledge of the secondary signs on magnetic resonance imaging and the typical distribution of osteomyelitis are key in distinguishing osteomyelitis from neuropathic disease.Key Words: imaging of the diabetic foot-diabetic pedal infectionosteomyelitis-neuropathy-diabetes related foot infection (Tech Orthop 2011;26: 262-270)

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Section: Nuclear Medicinementioning

confidence: 99%

Imaging the Diabetic Foot

Konin

Morrison

2011

Techniques in Orthopaedics

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“…The role of 18 F-FDG PET/CT in infection imaging is evolving rapidly and its role in diagnosis is comparable with other radiolabelled tracers. This topic has been extensively reviewed in several articles over the last few years [3,9,10]. However, it is worthwhile briefly to summarize some of the findings.…”

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confidence: 99%

“…Love et al reported sensitivity in the range of 36-100 % and specificity from 9 to 97 % [15] in assessing lower extremity joint replacements (accuracy of radiolabelled leukocyte/marrow imaging, in the same population, was 95 %) [15]. Therefore, 18 F-FDG PET cannot be considered as a suitable replacement for radiolabelled leukocyte/marrow imaging for diagnosing prosthetic joint infections at the present time [3,10,14].…”

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confidence: 99%

“…The sensitivity and specificity of 99m Tc-exametazime labelled leukocyte has ranged from 86 to 93 % and from 80 to 98 %, respectively [6,7,9]. Current evidence on the utility of 18 F-FDG PET/ CT in the diabetic foot is controversial as there are several positive papers with others less conclusive [3,9,10,[18][19][20][21].…”

mentioning

confidence: 99%

“…Based on the current evidence with 18 F-FDG PET, it is not possible to unequivocally support 18 F-FDG as the radiotracer of choice for the diabetic foot [6,9,10,14,20,21]. The limitations of the available data include variable methodology and differing patient populations, and more specifically (a) how images are interpreted: the use of visual image interpretation versus semi-quantitative (standardized uptake value/SUV) analysis [10,14], (b) the presence or absence of vascular insufficiency [10,14], (c) inconsistent correlation with MRI, (d) absence of histological confirmation, and (e) lack of crossover studies with radiolabelled leukocyte/marrow studies.…”

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confidence: 99%

See 2 more Smart Citations

Diagnosis of infection in the diabetic foot using 18F‐FDG PET/CT: a sweet alternative?

Gnanasegaran

Vijayanathan

Fogelman

2012

Eur J Nucl Med Mol Imaging

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IWGDF guidance on the diagnosis and management of foot infections in persons with diabetes

Lipsky

Aragón‐Sánchez

Diggle

et al. 2016

Diabetes Metabolism Res

495

561

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Recommendations Classification/diagnosis Diabetic foot infection must be diagnosed clinically, based on the presence of local or systemic signs or symptoms of inflammation (strong; low). Assess the severity of any diabetic foot infection using the Infectious Diseases Society of America/International Working Group on the Diabetic Foot classification scheme (strong; moderate). Osteomyelitis For an infected open wound, perform a probe‐to‐bone test; in a patient at low risk for osteomyelitis, a negative test largely rules out the diagnosis, while in a high‐risk patient, a positive test is largely diagnostic (strong; high). Markedly elevated serum inflammatory markers, especially erythrocyte sedimentation rate, are suggestive of osteomyelitis in suspected cases (weak; moderate). A definite diagnosis of bone infection usually requires positive results on microbiological (and, optimally, histological) examinations of an aseptically obtained bone sample, but this is usually required only when the diagnosis is in doubt or determining the causative pathogen's antibiotic susceptibility is crucial (strong; moderate). A probable diagnosis of bone infection is reasonable if there are positive results on a combination of diagnostic tests, such as probe‐to‐bone, serum inflammatory markers, plain X‐ray, magnetic resonance imaging (MRI) or radionuclide scanning (strong; weak). Avoid using results of soft tissue or sinus tract specimens for selecting antibiotic therapy for osteomyelitis as they do not accurately reflect bone culture results (strong; moderate). Obtain plain X‐rays of the foot in all cases of non‐superficial diabetic foot infection (strong; low). Use MRI when an advanced imaging test is needed for diagnosing diabetic foot osteomyelitis (strong; moderate). When MRI is not available or contraindicated, consider a white blood cell‐labelled radionuclide scan, or possibly single‐photon emission computed tomography (CT) and CT (SPECT/CT) or fluorine‐18‐fluorodeoxyglucose positron emission tomography/CT scans (weak; moderate). Assessing severity At initial evaluation of any infected foot, obtain vital signs and appropriate blood tests, debride the wound and probe and assess the depth and extent of the infection to establish its severity (strong; moderate). At initial evaluation, assess arterial perfusion and decide whether and when further vascular assessment or revascularization is needed (strong; low). Microbiological considerations Obtain cultures, preferably of a tissue specimen rather than a swab, of infected wounds to determine the causative microorganisms and their antibiotic sensitivity (strong; high). Do not obtain repeat cultures unless the patient is not clinically responding to treatment, or occasionally for infection control surveillance of resistant pathogens (strong; low). Send collected specimens to the microbiology laboratory promptly, in sterile transport containers, accompanied by clinical information on the type of specimen and location of the wound (strong; low). Surgical treatment Consult...

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¹⁸F-FDG and Diabetic Foot Infections: The Verdict Is…

Cited by 25 publications

References 15 publications

Imaging the Diabetic Foot

Imaging the Diabetic Foot

Diagnosis of infection in the diabetic foot using 18F‐FDG PET/CT: a sweet alternative?

IWGDF guidance on the diagnosis and management of foot infections in persons with diabetes

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18F-FDG and Diabetic Foot Infections: The Verdict Is…

Cited by 25 publications

References 15 publications

Imaging the Diabetic Foot

Imaging the Diabetic Foot

Diagnosis of infection in the diabetic foot using 18F‐FDG PET/CT: a sweet alternative?

IWGDF guidance on the diagnosis and management of foot infections in persons with diabetes

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Product

Resources

About

¹⁸F-FDG and Diabetic Foot Infections: The Verdict Is…