Detection of Osteomyelitis in the Diabetic Foot by Imaging Techniques: A Systematic Review and Meta-analysis Comparing MRI, White Blood Cell Scintigraphy, and FDG-PET
Diagnosing bone infection in the diabetic foot is challenging and often requires several diagnostic procedures, including advanced imaging. We compared the diagnostic performances of MRI, radiolabeled white blood cell (WBC) scintigraphy (either with Tc-hexamethylpropyleneamineoxime [HMPAO] or In-oxi...
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creator | Lauri, Chiara Tamminga, Menno Glaudemans, Andor W J M Juárez Orozco, Luis Eduardo Erba, Paola A Jutte, Paul C Lipsky, Benjamin A IJzerman, Maarten J Signore, Alberto Slart, Riemer H J A |
description | Diagnosing bone infection in the diabetic foot is challenging and often requires several diagnostic procedures, including advanced imaging. We compared the diagnostic performances of MRI, radiolabeled white blood cell (WBC) scintigraphy (either with
Tc-hexamethylpropyleneamineoxime [HMPAO] or
In-oxine), and [
F]fluorodeoxyglucose positron emission tomography (
F-FDG-PET)/computed tomography.
We searched Medline and Embase as of August 2016 for studies of diagnostic tests on patients known or suspected to have diabetes and a foot infection. We performed a systematic review using criteria recommended by the Cochrane Review of a database that included prospective and retrospective diagnostic studies performed on patients with diabetes in whom there was a clinical suspicion of osteomyelitis of the foot. The preferred reference standard was bone biopsy and subsequent pathological (or microbiological) examination.
Our review found 6,649 articles; 3,894 in Medline and 2,755 in Embase. A total of 27 full articles and 2 posters was selected for inclusion in the analysis. The performance characteristics for the
F-FDG-PET were: sensitivity, 89%; specificity, 92%; diagnostic odds ratio (DOR), 95; positive likelihood ratio (LR), 11; and negative LR, 0.11. For WBC scan with
In-oxine, the values were: sensitivity, 92%; specificity, 75%; DOR, 34; positive LR, 3.6; and negative LR, 0.1. For WBC scan with
Tc-HMPAO, the values were: sensitivity, 91%; specificity, 92%; DOR, 118; positive LR, 12; and negative LR, 0.1. Finally, for MRI, the values were: sensitivity, 93%; specificity, 75%; DOR, 37; positive LR, 3.66, and negative LR, 0.10.
The various modalities have similar sensitivity, but
F-FDG-PET and
Tc-HMPAO-labeled WBC scintigraphy offer the highest specificity. Larger prospective studies with a direct comparison among the different imaging techniques are required. |
doi_str_mv | 10.2337/dc17-0532 |
format | Article |
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Tc-hexamethylpropyleneamineoxime [HMPAO] or
In-oxine), and [
F]fluorodeoxyglucose positron emission tomography (
F-FDG-PET)/computed tomography.
We searched Medline and Embase as of August 2016 for studies of diagnostic tests on patients known or suspected to have diabetes and a foot infection. We performed a systematic review using criteria recommended by the Cochrane Review of a database that included prospective and retrospective diagnostic studies performed on patients with diabetes in whom there was a clinical suspicion of osteomyelitis of the foot. The preferred reference standard was bone biopsy and subsequent pathological (or microbiological) examination.
Our review found 6,649 articles; 3,894 in Medline and 2,755 in Embase. A total of 27 full articles and 2 posters was selected for inclusion in the analysis. The performance characteristics for the
F-FDG-PET were: sensitivity, 89%; specificity, 92%; diagnostic odds ratio (DOR), 95; positive likelihood ratio (LR), 11; and negative LR, 0.11. For WBC scan with
In-oxine, the values were: sensitivity, 92%; specificity, 75%; DOR, 34; positive LR, 3.6; and negative LR, 0.1. For WBC scan with
Tc-HMPAO, the values were: sensitivity, 91%; specificity, 92%; DOR, 118; positive LR, 12; and negative LR, 0.1. Finally, for MRI, the values were: sensitivity, 93%; specificity, 75%; DOR, 37; positive LR, 3.66, and negative LR, 0.10.
The various modalities have similar sensitivity, but
F-FDG-PET and
Tc-HMPAO-labeled WBC scintigraphy offer the highest specificity. Larger prospective studies with a direct comparison among the different imaging techniques are required.</description><identifier>ISSN: 0149-5992</identifier><identifier>EISSN: 1935-5548</identifier><identifier>DOI: 10.2337/dc17-0532</identifier><identifier>PMID: 28733376</identifier><language>eng</language><publisher>United States: American Diabetes Association</publisher><subject>Biocompatibility ; Biopsy ; Blood cells ; Bone and Bones - diagnostic imaging ; Bone and Bones - pathology ; Bone diseases ; Comparative analysis ; Computed tomography ; Databases, Factual ; Diabetes ; Diabetes mellitus ; Diabetic Foot - complications ; Diabetic Foot - pathology ; Diagnostic systems ; Evidence-based medicine ; Feet ; Foot diseases ; Humans ; Imaging techniques ; Infections ; Leukocytes ; Likelihood ratio ; Magnetic Resonance Imaging ; Medical diagnosis ; Meta-analysis ; NMR ; Nuclear magnetic resonance ; Osteomyelitis ; Osteomyelitis - complications ; Osteomyelitis - diagnostic imaging ; Patients ; Positron emission ; Positron emission tomography ; Radionuclide Imaging ; Research design ; Scintigraphy ; Sensitivity ; Sensitivity analysis ; Sensitivity and Specificity ; Systematic review ; Tomography</subject><ispartof>Diabetes care, 2017-08, Vol.40 (8), p.1111-1120</ispartof><rights>2017 by the American Diabetes Association.</rights><rights>Copyright American Diabetes Association Aug 2017</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c348t-b39e66db3cd69a4d17e1e7bf005e876a37b11c8b49e4d806372ca05c9b41a2893</citedby><cites>FETCH-LOGICAL-c348t-b39e66db3cd69a4d17e1e7bf005e876a37b11c8b49e4d806372ca05c9b41a2893</cites><orcidid>0000-0002-5565-1164</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28733376$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lauri, Chiara</creatorcontrib><creatorcontrib>Tamminga, Menno</creatorcontrib><creatorcontrib>Glaudemans, Andor W J M</creatorcontrib><creatorcontrib>Juárez Orozco, Luis Eduardo</creatorcontrib><creatorcontrib>Erba, Paola A</creatorcontrib><creatorcontrib>Jutte, Paul C</creatorcontrib><creatorcontrib>Lipsky, Benjamin A</creatorcontrib><creatorcontrib>IJzerman, Maarten J</creatorcontrib><creatorcontrib>Signore, Alberto</creatorcontrib><creatorcontrib>Slart, Riemer H J A</creatorcontrib><title>Detection of Osteomyelitis in the Diabetic Foot by Imaging Techniques: A Systematic Review and Meta-analysis Comparing MRI, White Blood Cell Scintigraphy, and FDG-PET</title><title>Diabetes care</title><addtitle>Diabetes Care</addtitle><description>Diagnosing bone infection in the diabetic foot is challenging and often requires several diagnostic procedures, including advanced imaging. We compared the diagnostic performances of MRI, radiolabeled white blood cell (WBC) scintigraphy (either with
Tc-hexamethylpropyleneamineoxime [HMPAO] or
In-oxine), and [
F]fluorodeoxyglucose positron emission tomography (
F-FDG-PET)/computed tomography.
We searched Medline and Embase as of August 2016 for studies of diagnostic tests on patients known or suspected to have diabetes and a foot infection. We performed a systematic review using criteria recommended by the Cochrane Review of a database that included prospective and retrospective diagnostic studies performed on patients with diabetes in whom there was a clinical suspicion of osteomyelitis of the foot. The preferred reference standard was bone biopsy and subsequent pathological (or microbiological) examination.
Our review found 6,649 articles; 3,894 in Medline and 2,755 in Embase. A total of 27 full articles and 2 posters was selected for inclusion in the analysis. The performance characteristics for the
F-FDG-PET were: sensitivity, 89%; specificity, 92%; diagnostic odds ratio (DOR), 95; positive likelihood ratio (LR), 11; and negative LR, 0.11. For WBC scan with
In-oxine, the values were: sensitivity, 92%; specificity, 75%; DOR, 34; positive LR, 3.6; and negative LR, 0.1. For WBC scan with
Tc-HMPAO, the values were: sensitivity, 91%; specificity, 92%; DOR, 118; positive LR, 12; and negative LR, 0.1. Finally, for MRI, the values were: sensitivity, 93%; specificity, 75%; DOR, 37; positive LR, 3.66, and negative LR, 0.10.
The various modalities have similar sensitivity, but
F-FDG-PET and
Tc-HMPAO-labeled WBC scintigraphy offer the highest specificity. Larger prospective studies with a direct comparison among the different imaging techniques are required.</description><subject>Biocompatibility</subject><subject>Biopsy</subject><subject>Blood cells</subject><subject>Bone and Bones - diagnostic imaging</subject><subject>Bone and Bones - pathology</subject><subject>Bone diseases</subject><subject>Comparative analysis</subject><subject>Computed tomography</subject><subject>Databases, Factual</subject><subject>Diabetes</subject><subject>Diabetes mellitus</subject><subject>Diabetic Foot - complications</subject><subject>Diabetic Foot - pathology</subject><subject>Diagnostic systems</subject><subject>Evidence-based medicine</subject><subject>Feet</subject><subject>Foot diseases</subject><subject>Humans</subject><subject>Imaging techniques</subject><subject>Infections</subject><subject>Leukocytes</subject><subject>Likelihood ratio</subject><subject>Magnetic Resonance Imaging</subject><subject>Medical diagnosis</subject><subject>Meta-analysis</subject><subject>NMR</subject><subject>Nuclear magnetic resonance</subject><subject>Osteomyelitis</subject><subject>Osteomyelitis - complications</subject><subject>Osteomyelitis - diagnostic imaging</subject><subject>Patients</subject><subject>Positron emission</subject><subject>Positron emission tomography</subject><subject>Radionuclide Imaging</subject><subject>Research design</subject><subject>Scintigraphy</subject><subject>Sensitivity</subject><subject>Sensitivity analysis</subject><subject>Sensitivity and Specificity</subject><subject>Systematic review</subject><subject>Tomography</subject><issn>0149-5992</issn><issn>1935-5548</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkc1u1DAUhS0EokNhwQsgS2xAasC_sc2uzHTKSK2K2kEsI9u5M-MqiYfY0yovxHOStIUFq7v5ztE9-hB6S8knxrn6XHuqCiI5e4Zm1HBZSCn0czQjVJhCGsOO0KuUbgkhQmj9Eh0xrfgYLGfo9wIy-Bxih-MGX6UMsR2gCTkkHDqcd4AXwTrIweNljBm7Aa9auw3dFq_B77rw6wDpCz7FN8MYbu0EXsNdgHtsuxpfQraF7WwzpLFxHtu97afs5fXqBP_chQz4axNjjefQNPjGhy6HbW_3u-HkIb9cnBffz9av0YuNbRK8ebrH6MfybD3_Vlxcna_mpxeF50LnwnEDZVk77uvSWFFTBRSU2xAiQavScuUo9doJA6LWpOSKeUukN05Qy7Thx-jDY---j9OwXLUh-fE120E8pIoaxiTRpZzQ9_-ht_HQj0sfKCNYqSgZqY-PlO9jSj1sqn0fWtsPFSXVJK-a5FWTvJF999R4cC3U_8i_tvgf_heUAw</recordid><startdate>201708</startdate><enddate>201708</enddate><creator>Lauri, Chiara</creator><creator>Tamminga, Menno</creator><creator>Glaudemans, Andor W J M</creator><creator>Juárez Orozco, Luis Eduardo</creator><creator>Erba, Paola A</creator><creator>Jutte, Paul C</creator><creator>Lipsky, Benjamin A</creator><creator>IJzerman, Maarten J</creator><creator>Signore, Alberto</creator><creator>Slart, Riemer H J A</creator><general>American Diabetes Association</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>NAPCQ</scope><orcidid>https://orcid.org/0000-0002-5565-1164</orcidid></search><sort><creationdate>201708</creationdate><title>Detection of Osteomyelitis in the Diabetic Foot by Imaging Techniques: A Systematic Review and Meta-analysis Comparing MRI, White Blood Cell Scintigraphy, and FDG-PET</title><author>Lauri, Chiara ; Tamminga, Menno ; Glaudemans, Andor W J M ; Juárez Orozco, Luis Eduardo ; Erba, Paola A ; Jutte, Paul C ; Lipsky, Benjamin A ; IJzerman, Maarten J ; Signore, Alberto ; Slart, Riemer H J A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c348t-b39e66db3cd69a4d17e1e7bf005e876a37b11c8b49e4d806372ca05c9b41a2893</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Biocompatibility</topic><topic>Biopsy</topic><topic>Blood cells</topic><topic>Bone and Bones - diagnostic imaging</topic><topic>Bone and Bones - pathology</topic><topic>Bone diseases</topic><topic>Comparative analysis</topic><topic>Computed tomography</topic><topic>Databases, Factual</topic><topic>Diabetes</topic><topic>Diabetes mellitus</topic><topic>Diabetic Foot - complications</topic><topic>Diabetic Foot - pathology</topic><topic>Diagnostic systems</topic><topic>Evidence-based medicine</topic><topic>Feet</topic><topic>Foot diseases</topic><topic>Humans</topic><topic>Imaging techniques</topic><topic>Infections</topic><topic>Leukocytes</topic><topic>Likelihood ratio</topic><topic>Magnetic Resonance Imaging</topic><topic>Medical diagnosis</topic><topic>Meta-analysis</topic><topic>NMR</topic><topic>Nuclear magnetic resonance</topic><topic>Osteomyelitis</topic><topic>Osteomyelitis - complications</topic><topic>Osteomyelitis - diagnostic imaging</topic><topic>Patients</topic><topic>Positron emission</topic><topic>Positron emission tomography</topic><topic>Radionuclide Imaging</topic><topic>Research design</topic><topic>Scintigraphy</topic><topic>Sensitivity</topic><topic>Sensitivity analysis</topic><topic>Sensitivity and Specificity</topic><topic>Systematic review</topic><topic>Tomography</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lauri, Chiara</creatorcontrib><creatorcontrib>Tamminga, Menno</creatorcontrib><creatorcontrib>Glaudemans, Andor W J M</creatorcontrib><creatorcontrib>Juárez Orozco, Luis Eduardo</creatorcontrib><creatorcontrib>Erba, Paola A</creatorcontrib><creatorcontrib>Jutte, Paul C</creatorcontrib><creatorcontrib>Lipsky, Benjamin A</creatorcontrib><creatorcontrib>IJzerman, Maarten J</creatorcontrib><creatorcontrib>Signore, Alberto</creatorcontrib><creatorcontrib>Slart, Riemer H J A</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><jtitle>Diabetes care</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lauri, Chiara</au><au>Tamminga, Menno</au><au>Glaudemans, Andor W J M</au><au>Juárez Orozco, Luis Eduardo</au><au>Erba, Paola A</au><au>Jutte, Paul C</au><au>Lipsky, Benjamin A</au><au>IJzerman, Maarten J</au><au>Signore, Alberto</au><au>Slart, Riemer H J A</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Detection of Osteomyelitis in the Diabetic Foot by Imaging Techniques: A Systematic Review and Meta-analysis Comparing MRI, White Blood Cell Scintigraphy, and FDG-PET</atitle><jtitle>Diabetes care</jtitle><addtitle>Diabetes Care</addtitle><date>2017-08</date><risdate>2017</risdate><volume>40</volume><issue>8</issue><spage>1111</spage><epage>1120</epage><pages>1111-1120</pages><issn>0149-5992</issn><eissn>1935-5548</eissn><abstract>Diagnosing bone infection in the diabetic foot is challenging and often requires several diagnostic procedures, including advanced imaging. We compared the diagnostic performances of MRI, radiolabeled white blood cell (WBC) scintigraphy (either with
Tc-hexamethylpropyleneamineoxime [HMPAO] or
In-oxine), and [
F]fluorodeoxyglucose positron emission tomography (
F-FDG-PET)/computed tomography.
We searched Medline and Embase as of August 2016 for studies of diagnostic tests on patients known or suspected to have diabetes and a foot infection. We performed a systematic review using criteria recommended by the Cochrane Review of a database that included prospective and retrospective diagnostic studies performed on patients with diabetes in whom there was a clinical suspicion of osteomyelitis of the foot. The preferred reference standard was bone biopsy and subsequent pathological (or microbiological) examination.
Our review found 6,649 articles; 3,894 in Medline and 2,755 in Embase. A total of 27 full articles and 2 posters was selected for inclusion in the analysis. The performance characteristics for the
F-FDG-PET were: sensitivity, 89%; specificity, 92%; diagnostic odds ratio (DOR), 95; positive likelihood ratio (LR), 11; and negative LR, 0.11. For WBC scan with
In-oxine, the values were: sensitivity, 92%; specificity, 75%; DOR, 34; positive LR, 3.6; and negative LR, 0.1. For WBC scan with
Tc-HMPAO, the values were: sensitivity, 91%; specificity, 92%; DOR, 118; positive LR, 12; and negative LR, 0.1. Finally, for MRI, the values were: sensitivity, 93%; specificity, 75%; DOR, 37; positive LR, 3.66, and negative LR, 0.10.
The various modalities have similar sensitivity, but
F-FDG-PET and
Tc-HMPAO-labeled WBC scintigraphy offer the highest specificity. Larger prospective studies with a direct comparison among the different imaging techniques are required.</abstract><cop>United States</cop><pub>American Diabetes Association</pub><pmid>28733376</pmid><doi>10.2337/dc17-0532</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0002-5565-1164</orcidid><oa>free_for_read</oa></addata></record> |
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subjects | Biocompatibility Biopsy Blood cells Bone and Bones - diagnostic imaging Bone and Bones - pathology Bone diseases Comparative analysis Computed tomography Databases, Factual Diabetes Diabetes mellitus Diabetic Foot - complications Diabetic Foot - pathology Diagnostic systems Evidence-based medicine Feet Foot diseases Humans Imaging techniques Infections Leukocytes Likelihood ratio Magnetic Resonance Imaging Medical diagnosis Meta-analysis NMR Nuclear magnetic resonance Osteomyelitis Osteomyelitis - complications Osteomyelitis - diagnostic imaging Patients Positron emission Positron emission tomography Radionuclide Imaging Research design Scintigraphy Sensitivity Sensitivity analysis Sensitivity and Specificity Systematic review Tomography |
title | Detection of Osteomyelitis in the Diabetic Foot by Imaging Techniques: A Systematic Review and Meta-analysis Comparing MRI, White Blood Cell Scintigraphy, and FDG-PET |
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