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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Veröffentlicht in:Diabetes care 2017-08, Vol.40 (8), p.1111-1120
Hauptverfasser: 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
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container_end_page 1120
container_issue 8
container_start_page 1111
container_title Diabetes care
container_volume 40
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
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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. 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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. 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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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