| Abstrakt: |
Background and objectives: Osteomyelitis (OM), Foot Ulcers (FU) and neuropathic arthropathies, i.e. Charcot's Foot (CF) are complications of Diabetes Mellitus (DM) which can coexist. This retrospective study was undertaken to highlight the sensitivity of bone scan in diagnosing OM, to study patterns of 99mTc Methylene DiPhosphonate (MDP) bone and 67Gallium (Gallium citrate) uptake, their sensitivity in Charcot's detection and whether Gallium can be a useful cost effective adjunct imaging in evaluation of diabetic osteopathy.Methods: 86 diabetic patients (M:F = 50:36) in age range 46-75 years (mean 52 ± 6 years) with clinical suspicion of OM/CF with normal X-rays were analyzed. All patients underwent 99mTc MDP three phase bone scan. A combined 67Ga scans were performed in 14 patients. OM positive patients further had bone curettage and bacteriological culture.Results: Of 86 patients, bone scan. wise, 34 had OM and 31 had positive bacteriological cultures. 15 patients showed no OM or CF. In remaining 37 patients, 16 (Group: A) had OM in metatarsal bones/phalanges apart from hot spots in other tarsal bones, with no clinical evidence of foot ulcers suggesting coexisting unsuspected CF. 21 patients (Group: B) showed tracer uptake only in tarsal bones with no coexisting foot ulcers ('CF Group').67Ga imaging was performed in 14 patients (6 from Group: A and 8 from Group: B) showing variable uptake patterns. In Group: A all six patients showed moderate congruent 67Ga and MDP uptake in sites of OM and three of them showed congruent but less 67Ga uptake in tarsals. In Group: B, three showed moderate 67Ga uptake congruent to MDP uptake in tarsals and five patients there is nil to mild uptake.Conclusion: Our study shows three-phase bone scan has 100% sensitivity and 91.2% specificity for detecting diabetic Osteomyelitis in presence of normal X-rays. Bone scan is a simple and useful screening modality to detect OM and unsuspected cases of Charcot's foot in diabetics. Navicular and cuneiform bones are earliest to be involved in Charcot's foot. 67Gallium imaging has little incremental value in evaluation of diabetic osteopathy. [ABSTRACT FROM AUTHOR] |
Full Text from ScienceDirect