FDG-PET/CT can be used in the evaluation of patients with metal implants that would compromise the accuracy of MRI or CT [40]. Prior studies have demonstrated high accuracy in the detection of osteomyelitis in cases complicated by prior surgery, trauma, and the presence of orthopedic hardware [44-46]. 3-phase Bone Scan and WBC Scan with SPECT or SPECT/CT Foot Planar scintigraphic imaging modalities have relatively low spatial resolution and lack anatomic specificity. SPECT/CT fused imaging improves the diagnostic accuracy mainly because of accurate anatomic localization [47-50]. Dual isotope SPECT/CT is reported to be more accurate than bone scan SPECT/CT or WBC-SPECT/CT alone [51]. Variant 3: Soft-tissue swelling with ulcer. Suspected osteomyelitis of the foot in patients with diabetes mellitus with or without neuropathic arthropathy. Additional imaging following radiographs. Imaging plays a central role in characterizing soft-tissue and osseous infections in the diabetic foot by identifying the location, evaluating the extent of involvement, and detecting complications, such as soft-tissue abscesses or sinus tracts. The infected ulcer may progress to soft-tissue abscess, sinus tract, infected tendon sheath, osteomyelitis, or septic arthritis [29]. If an ulcer with a positive probe-to-bone test is present, the risk of osteomyelitis is 12% to 66% [52-54]. The role of any imaging modality in these patients is to confirm the presence of soft-tissue or osseous infection and determine the anatomic extent for treatment planning. US Foot US demonstrates limited benefit in the detection of adult osteomyelitis because of its inability to penetrate the cortex of the bone. The role of US in the diabetic foot includes detecting subperiosteal and soft-tissue abscesses, tenosynovitis, joint effusions, and radiolucent foreign bodies. US is insensitive to the marrow edema and trabecular microfractures present in neuropathic foot.
Suspected Osteomyelitis of the Foot in Patients with Diabetes Mellitus. FDG-PET/CT can be used in the evaluation of patients with metal implants that would compromise the accuracy of MRI or CT [40]. Prior studies have demonstrated high accuracy in the detection of osteomyelitis in cases complicated by prior surgery, trauma, and the presence of orthopedic hardware [44-46]. 3-phase Bone Scan and WBC Scan with SPECT or SPECT/CT Foot Planar scintigraphic imaging modalities have relatively low spatial resolution and lack anatomic specificity. SPECT/CT fused imaging improves the diagnostic accuracy mainly because of accurate anatomic localization [47-50]. Dual isotope SPECT/CT is reported to be more accurate than bone scan SPECT/CT or WBC-SPECT/CT alone [51]. Variant 3: Soft-tissue swelling with ulcer. Suspected osteomyelitis of the foot in patients with diabetes mellitus with or without neuropathic arthropathy. Additional imaging following radiographs. Imaging plays a central role in characterizing soft-tissue and osseous infections in the diabetic foot by identifying the location, evaluating the extent of involvement, and detecting complications, such as soft-tissue abscesses or sinus tracts. The infected ulcer may progress to soft-tissue abscess, sinus tract, infected tendon sheath, osteomyelitis, or septic arthritis [29]. If an ulcer with a positive probe-to-bone test is present, the risk of osteomyelitis is 12% to 66% [52-54]. The role of any imaging modality in these patients is to confirm the presence of soft-tissue or osseous infection and determine the anatomic extent for treatment planning. US Foot US demonstrates limited benefit in the detection of adult osteomyelitis because of its inability to penetrate the cortex of the bone. The role of US in the diabetic foot includes detecting subperiosteal and soft-tissue abscesses, tenosynovitis, joint effusions, and radiolucent foreign bodies. US is insensitive to the marrow edema and trabecular microfractures present in neuropathic foot.