The Optimized Evaluation of Diabetic Foot Infection by Dual Isotope SPECT/CT Imaging Protocol
Abstract Sequential Tc-99m hydroxymethylene-diphosphonate (HDP) 3-phase bone (BS) and In-111 leukocyte scanning (WBCS) have been frequently used to evaluate the diabetic foot, as nonosteomyelitis BS uptake is repeatedly observed and osteomyelitis (OM) in WBCS is often uncertain without BS correlatio...
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| creator | Heiba, Sherif I., MD Kolker, Dov, MD Mocherla, Bharat, MD Kapoor, Karan, MD Jiang, Manli, MD Son, Hongju, MD Rangaswamy, Balasubramanya, MD Kostakoglu, Lale, MD Savitch, Ina, MD DaCosta, Maria, CNMT Machac, Josef, MD |
| description | Abstract Sequential Tc-99m hydroxymethylene-diphosphonate (HDP) 3-phase bone (BS) and In-111 leukocyte scanning (WBCS) have been frequently used to evaluate the diabetic foot, as nonosteomyelitis BS uptake is repeatedly observed and osteomyelitis (OM) in WBCS is often uncertain without BS correlation. Additionally, both modalities are limited in lesion localization because of low resolution and lack of anatomic details. We investigated a method that combined BS/WBCS, and if needed, WBCS/bone marrow scanning (BMS) using SPECT/CT to accurately diagnose/localize infection in a practical protocol. Blood flow/pool images were obtained followed by WBC reinjection and next day dual isotope (DI) BS/WBCS planar and SPECT/CT. BMS/WBCS SPECT/CT (step 2 DI) was obtained on the following day when images were suspicious for mid/hindfoot OM. Diagnosis accuracy and confidence were judged for the various imaging combinations. Diagnosis was classified as OM, soft tissue infection (STI), both OM/STI, and other/no bony pathology by microbiology/pathology or follow-up. Distinction between various diagnostic categories and overall OM diagnostic accuracy in 213 patients were higher for DI than WBCS or BS alone, and for DI SPECT/CT than DI planar or SPECT only. Diagnostic confidence/lesion site was significantly higher for DI SPECT/CT than other comparative imaging methods. In a group of 97 patients with confirmed microbiologic/pathologic diagnosis, similar results were attained. Step 2 DI SPECT/CT performed in 67 patients further improved diagnostic accuracy/confidence. DI SPECT/CT is a highly accurate modality that considerably improves detection and discrimination of STI and OM while providing precise anatomic localization in the diabetic foot. This combined imaging technique promises to beneficially impact diabetic patient care. |
| doi_str_mv | 10.1053/j.jfas.2010.07.010 |
| format | Article |
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Additionally, both modalities are limited in lesion localization because of low resolution and lack of anatomic details. We investigated a method that combined BS/WBCS, and if needed, WBCS/bone marrow scanning (BMS) using SPECT/CT to accurately diagnose/localize infection in a practical protocol. Blood flow/pool images were obtained followed by WBC reinjection and next day dual isotope (DI) BS/WBCS planar and SPECT/CT. BMS/WBCS SPECT/CT (step 2 DI) was obtained on the following day when images were suspicious for mid/hindfoot OM. Diagnosis accuracy and confidence were judged for the various imaging combinations. Diagnosis was classified as OM, soft tissue infection (STI), both OM/STI, and other/no bony pathology by microbiology/pathology or follow-up. Distinction between various diagnostic categories and overall OM diagnostic accuracy in 213 patients were higher for DI than WBCS or BS alone, and for DI SPECT/CT than DI planar or SPECT only. Diagnostic confidence/lesion site was significantly higher for DI SPECT/CT than other comparative imaging methods. In a group of 97 patients with confirmed microbiologic/pathologic diagnosis, similar results were attained. Step 2 DI SPECT/CT performed in 67 patients further improved diagnostic accuracy/confidence. DI SPECT/CT is a highly accurate modality that considerably improves detection and discrimination of STI and OM while providing precise anatomic localization in the diabetic foot. This combined imaging technique promises to beneficially impact diabetic patient care.</description><identifier>ISSN: 1067-2516</identifier><identifier>EISSN: 1542-2224</identifier><identifier>DOI: 10.1053/j.jfas.2010.07.010</identifier><identifier>PMID: 20851003</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Associated diseases and complications ; Bacterial arthritis and osteitis ; Bacterial diseases ; Biological and medical sciences ; bone biopsy ; Diabetes. Impaired glucose tolerance ; Diabetic Foot - microbiology ; Diseases of the osteoarticular system ; Endocrine pancreas. Apud cells (diseases) ; Endocrinopathies ; False Negative Reactions ; False Positive Reactions ; Female ; Human bacterial diseases ; Humans ; Indium Radioisotopes ; Infectious diseases ; Leukocyte Count ; Male ; Medical sciences ; Middle Aged ; Orthopedics ; osteomyelitis ; Osteomyelitis - diagnosis ; peripheral neuropathy ; positron emission tomography ; Predictive Value of Tests ; Radiopharmaceuticals ; Retrospective Studies ; scan ; Sensitivity and Specificity ; Soft Tissue Infections - diagnosis ; Technetium Tc 99m Medronate - analogs & derivatives ; Tomography, Emission-Computed, Single-Photon ; Tomography, X-Ray Computed</subject><ispartof>The Journal of foot and ankle surgery, 2010-11, Vol.49 (6), p.529-536</ispartof><rights>American College of Foot and Ankle Surgeons</rights><rights>2010 American College of Foot and Ankle Surgeons</rights><rights>2015 INIST-CNRS</rights><rights>Copyright © 2010 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c440t-c2e16ffc37df124c9d5a60de5a32f1c82274470113d2462e70ed4ffc6a2d8d423</citedby><cites>FETCH-LOGICAL-c440t-c2e16ffc37df124c9d5a60de5a32f1c82274470113d2462e70ed4ffc6a2d8d423</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1067251610002851$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=23531081$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20851003$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Heiba, Sherif I., MD</creatorcontrib><creatorcontrib>Kolker, Dov, MD</creatorcontrib><creatorcontrib>Mocherla, Bharat, MD</creatorcontrib><creatorcontrib>Kapoor, Karan, MD</creatorcontrib><creatorcontrib>Jiang, Manli, MD</creatorcontrib><creatorcontrib>Son, Hongju, MD</creatorcontrib><creatorcontrib>Rangaswamy, Balasubramanya, MD</creatorcontrib><creatorcontrib>Kostakoglu, Lale, MD</creatorcontrib><creatorcontrib>Savitch, Ina, MD</creatorcontrib><creatorcontrib>DaCosta, Maria, CNMT</creatorcontrib><creatorcontrib>Machac, Josef, MD</creatorcontrib><title>The Optimized Evaluation of Diabetic Foot Infection by Dual Isotope SPECT/CT Imaging Protocol</title><title>The Journal of foot and ankle surgery</title><addtitle>J Foot Ankle Surg</addtitle><description>Abstract Sequential Tc-99m hydroxymethylene-diphosphonate (HDP) 3-phase bone (BS) and In-111 leukocyte scanning (WBCS) have been frequently used to evaluate the diabetic foot, as nonosteomyelitis BS uptake is repeatedly observed and osteomyelitis (OM) in WBCS is often uncertain without BS correlation. Additionally, both modalities are limited in lesion localization because of low resolution and lack of anatomic details. We investigated a method that combined BS/WBCS, and if needed, WBCS/bone marrow scanning (BMS) using SPECT/CT to accurately diagnose/localize infection in a practical protocol. Blood flow/pool images were obtained followed by WBC reinjection and next day dual isotope (DI) BS/WBCS planar and SPECT/CT. BMS/WBCS SPECT/CT (step 2 DI) was obtained on the following day when images were suspicious for mid/hindfoot OM. Diagnosis accuracy and confidence were judged for the various imaging combinations. Diagnosis was classified as OM, soft tissue infection (STI), both OM/STI, and other/no bony pathology by microbiology/pathology or follow-up. Distinction between various diagnostic categories and overall OM diagnostic accuracy in 213 patients were higher for DI than WBCS or BS alone, and for DI SPECT/CT than DI planar or SPECT only. Diagnostic confidence/lesion site was significantly higher for DI SPECT/CT than other comparative imaging methods. In a group of 97 patients with confirmed microbiologic/pathologic diagnosis, similar results were attained. Step 2 DI SPECT/CT performed in 67 patients further improved diagnostic accuracy/confidence. DI SPECT/CT is a highly accurate modality that considerably improves detection and discrimination of STI and OM while providing precise anatomic localization in the diabetic foot. This combined imaging technique promises to beneficially impact diabetic patient care.</description><subject>Associated diseases and complications</subject><subject>Bacterial arthritis and osteitis</subject><subject>Bacterial diseases</subject><subject>Biological and medical sciences</subject><subject>bone biopsy</subject><subject>Diabetes. Impaired glucose tolerance</subject><subject>Diabetic Foot - microbiology</subject><subject>Diseases of the osteoarticular system</subject><subject>Endocrine pancreas. Apud cells (diseases)</subject><subject>Endocrinopathies</subject><subject>False Negative Reactions</subject><subject>False Positive Reactions</subject><subject>Female</subject><subject>Human bacterial diseases</subject><subject>Humans</subject><subject>Indium Radioisotopes</subject><subject>Infectious diseases</subject><subject>Leukocyte Count</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Orthopedics</subject><subject>osteomyelitis</subject><subject>Osteomyelitis - diagnosis</subject><subject>peripheral neuropathy</subject><subject>positron emission tomography</subject><subject>Predictive Value of Tests</subject><subject>Radiopharmaceuticals</subject><subject>Retrospective Studies</subject><subject>scan</subject><subject>Sensitivity and Specificity</subject><subject>Soft Tissue Infections - diagnosis</subject><subject>Technetium Tc 99m Medronate - analogs & derivatives</subject><subject>Tomography, Emission-Computed, Single-Photon</subject><subject>Tomography, X-Ray Computed</subject><issn>1067-2516</issn><issn>1542-2224</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kd1rFDEQwBdRbK3-Az5IXsSnvU4m-1UQQa5XPSi00PNRQi6Z1Ky7m2uyWzj_erPeqeCDTxMyv_ngN1n2msOCQynO20VrVVwgpA-oFyk8yU55WWCOiMXT9IaqzrHk1Un2IsYWAPGiKZ9nJwhNyQHEafZ1843YzW50vftBhq0eVTep0fmBecsundrS6DS78n5k68GS_pXa7tnlpDq2jn70O2J3t6vl5ny5Yete3bvhnt2GlNC-e5k9s6qL9OoYz7IvV6vN8nN-ffNpvfx4neuigDHXSLyyVovaWI6FvjClqsBQqQRarhvEuihq4FwYLCqkGsgUia8UmsYUKM6yd4e-u-AfJoqj7F3U1HVqID9FWVcIgpe8SSQeSB18jIGs3AXXq7CXHORsVbZytipnqxJqmUIqenNsP217Mn9KfmtMwNsjoKJWnQ1q0C7-5UQpODQ8ce8PHCUZj46CjNrRoMm4kNxK493_9_jwT7nu3ODSxO-0p9j6KQxJs-QyogR5N99_Pn_aETCtKn4CY5Koyg</recordid><startdate>20101101</startdate><enddate>20101101</enddate><creator>Heiba, Sherif I., MD</creator><creator>Kolker, Dov, MD</creator><creator>Mocherla, Bharat, MD</creator><creator>Kapoor, Karan, MD</creator><creator>Jiang, Manli, MD</creator><creator>Son, Hongju, MD</creator><creator>Rangaswamy, Balasubramanya, MD</creator><creator>Kostakoglu, Lale, MD</creator><creator>Savitch, Ina, MD</creator><creator>DaCosta, Maria, CNMT</creator><creator>Machac, Josef, MD</creator><general>Elsevier Inc</general><general>Elsevier</general><scope>IQODW</scope><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>7X8</scope></search><sort><creationdate>20101101</creationdate><title>The Optimized Evaluation of Diabetic Foot Infection by Dual Isotope SPECT/CT Imaging Protocol</title><author>Heiba, Sherif I., MD ; Kolker, Dov, MD ; Mocherla, Bharat, MD ; Kapoor, Karan, MD ; Jiang, Manli, MD ; Son, Hongju, MD ; Rangaswamy, Balasubramanya, MD ; Kostakoglu, Lale, MD ; Savitch, Ina, MD ; DaCosta, Maria, CNMT ; Machac, Josef, MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c440t-c2e16ffc37df124c9d5a60de5a32f1c82274470113d2462e70ed4ffc6a2d8d423</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Associated diseases and complications</topic><topic>Bacterial arthritis and osteitis</topic><topic>Bacterial diseases</topic><topic>Biological and medical sciences</topic><topic>bone biopsy</topic><topic>Diabetes. Impaired glucose tolerance</topic><topic>Diabetic Foot - microbiology</topic><topic>Diseases of the osteoarticular system</topic><topic>Endocrine pancreas. Apud cells (diseases)</topic><topic>Endocrinopathies</topic><topic>False Negative Reactions</topic><topic>False Positive Reactions</topic><topic>Female</topic><topic>Human bacterial diseases</topic><topic>Humans</topic><topic>Indium Radioisotopes</topic><topic>Infectious diseases</topic><topic>Leukocyte Count</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Orthopedics</topic><topic>osteomyelitis</topic><topic>Osteomyelitis - diagnosis</topic><topic>peripheral neuropathy</topic><topic>positron emission tomography</topic><topic>Predictive Value of Tests</topic><topic>Radiopharmaceuticals</topic><topic>Retrospective Studies</topic><topic>scan</topic><topic>Sensitivity and Specificity</topic><topic>Soft Tissue Infections - diagnosis</topic><topic>Technetium Tc 99m Medronate - analogs & derivatives</topic><topic>Tomography, Emission-Computed, Single-Photon</topic><topic>Tomography, X-Ray Computed</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Heiba, Sherif I., MD</creatorcontrib><creatorcontrib>Kolker, Dov, MD</creatorcontrib><creatorcontrib>Mocherla, Bharat, MD</creatorcontrib><creatorcontrib>Kapoor, Karan, MD</creatorcontrib><creatorcontrib>Jiang, Manli, MD</creatorcontrib><creatorcontrib>Son, Hongju, MD</creatorcontrib><creatorcontrib>Rangaswamy, Balasubramanya, MD</creatorcontrib><creatorcontrib>Kostakoglu, Lale, MD</creatorcontrib><creatorcontrib>Savitch, Ina, MD</creatorcontrib><creatorcontrib>DaCosta, Maria, CNMT</creatorcontrib><creatorcontrib>Machac, Josef, MD</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of foot and ankle surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Heiba, Sherif I., MD</au><au>Kolker, Dov, MD</au><au>Mocherla, Bharat, MD</au><au>Kapoor, Karan, MD</au><au>Jiang, Manli, MD</au><au>Son, Hongju, MD</au><au>Rangaswamy, Balasubramanya, MD</au><au>Kostakoglu, Lale, MD</au><au>Savitch, Ina, MD</au><au>DaCosta, Maria, CNMT</au><au>Machac, Josef, MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The Optimized Evaluation of Diabetic Foot Infection by Dual Isotope SPECT/CT Imaging Protocol</atitle><jtitle>The Journal of foot and ankle surgery</jtitle><addtitle>J Foot Ankle Surg</addtitle><date>2010-11-01</date><risdate>2010</risdate><volume>49</volume><issue>6</issue><spage>529</spage><epage>536</epage><pages>529-536</pages><issn>1067-2516</issn><eissn>1542-2224</eissn><abstract>Abstract Sequential Tc-99m hydroxymethylene-diphosphonate (HDP) 3-phase bone (BS) and In-111 leukocyte scanning (WBCS) have been frequently used to evaluate the diabetic foot, as nonosteomyelitis BS uptake is repeatedly observed and osteomyelitis (OM) in WBCS is often uncertain without BS correlation. Additionally, both modalities are limited in lesion localization because of low resolution and lack of anatomic details. We investigated a method that combined BS/WBCS, and if needed, WBCS/bone marrow scanning (BMS) using SPECT/CT to accurately diagnose/localize infection in a practical protocol. Blood flow/pool images were obtained followed by WBC reinjection and next day dual isotope (DI) BS/WBCS planar and SPECT/CT. BMS/WBCS SPECT/CT (step 2 DI) was obtained on the following day when images were suspicious for mid/hindfoot OM. Diagnosis accuracy and confidence were judged for the various imaging combinations. Diagnosis was classified as OM, soft tissue infection (STI), both OM/STI, and other/no bony pathology by microbiology/pathology or follow-up. Distinction between various diagnostic categories and overall OM diagnostic accuracy in 213 patients were higher for DI than WBCS or BS alone, and for DI SPECT/CT than DI planar or SPECT only. Diagnostic confidence/lesion site was significantly higher for DI SPECT/CT than other comparative imaging methods. In a group of 97 patients with confirmed microbiologic/pathologic diagnosis, similar results were attained. Step 2 DI SPECT/CT performed in 67 patients further improved diagnostic accuracy/confidence. DI SPECT/CT is a highly accurate modality that considerably improves detection and discrimination of STI and OM while providing precise anatomic localization in the diabetic foot. This combined imaging technique promises to beneficially impact diabetic patient care.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>20851003</pmid><doi>10.1053/j.jfas.2010.07.010</doi><tpages>8</tpages></addata></record> |
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| subjects | Associated diseases and complications Bacterial arthritis and osteitis Bacterial diseases Biological and medical sciences bone biopsy Diabetes. Impaired glucose tolerance Diabetic Foot - microbiology Diseases of the osteoarticular system Endocrine pancreas. Apud cells (diseases) Endocrinopathies False Negative Reactions False Positive Reactions Female Human bacterial diseases Humans Indium Radioisotopes Infectious diseases Leukocyte Count Male Medical sciences Middle Aged Orthopedics osteomyelitis Osteomyelitis - diagnosis peripheral neuropathy positron emission tomography Predictive Value of Tests Radiopharmaceuticals Retrospective Studies scan Sensitivity and Specificity Soft Tissue Infections - diagnosis Technetium Tc 99m Medronate - analogs & derivatives Tomography, Emission-Computed, Single-Photon Tomography, X-Ray Computed |
| title | The Optimized Evaluation of Diabetic Foot Infection by Dual Isotope SPECT/CT Imaging Protocol |
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