Can Sequential F-18-FDG PET/CT Replace WBC Imaging in the Diabetic Foot?
| Autor: | Demetrio Familiari, Francesco Scopinaro, Alberto Signore, Oreste Bagni, Andrea Lenza, Daniela Prosperi, Andor W. J. M. Glaudemans, Valeria Vitale, Marco Cavallini |
|---|---|
| Přispěvatelé: | Translational Immunology Groningen (TRIGR) |
| Jazyk: | angličtina |
| Rok vydání: | 2011 |
| Předmět: |
Male
Time Factors Image Processing Scintigraphy GUIDELINES UNSUSPECTED OSTEOMYELITIS Computer-Assisted Nuclear Medicine and Imaging INFECTION Image Processing Computer-Assisted 80 and over Leukocytes Tomography white blood cell scintigraphy Aged 80 and over medicine.diagnostic_test Medicine (all) osteomyelitis Middle Aged X-Ray Computed ULCERS Positron emission tomography Radiology diabetic foot Diabetic foot Infection Osteomyelitis PET/CT White blood cell scintigraphy Aged Diabetic Foot Diagnosis Differential Humans Sensitivity and Specificity Soft Tissue Infections Technetium Tc 99m Exametazime Fluorodeoxyglucose F18 Positron-Emission Tomography Tomography X-Ray Computed Radiology Nuclear Medicine and Imaging medicine.medical_specialty Standardized uptake value DIAGNOSIS Biopsy medicine Radiology Nuclear Medicine and imaging PET-CT business.industry Gold standard (test) medicine.disease Differential business CONSENSUS |
| Zdroj: | Journal of Nuclear Medicine, 52(7), 1012-1019. SOC NUCLEAR MEDICINE INC |
| ISSN: | 1535-5667 0161-5505 |
| Popis: | White blood cell (WBC) scintigraphy is considered the nuclear medicine imaging gold standard for diagnosing osteomyelitis in the diabetic foot. Recent papers have suggested that the use of F-18-FDG PET/CT produces similar diagnostic accuracy, but clear interpretation criteria have not yet been established. Our aim was to evaluate the role of sequential F-18-FDG PET/CT in patients with a high suspicion of osteomyelitis to define objective interpretation criteria to be compared with WBC scintigraphy. Methods: Thirteen patients whom clinicians considered positive for osteomyelitis (7 with ulcers, 6 with exposed bone) were enrolled. The patients underwent Tc-99m-exametazime WBC scintigraphy with acquisition times of 30 min, 3 h, and 20 h and sequential F-18-FDG PET/CT with acquisition times of 10 min, 1 h, and 2 h. A biopsy or tissue culture was performed for final diagnosis. Several interpretation criteria (qualitative and quantitative) were tested. Results: At final biopsy, 7 patients had osteomyelitis, 2 had soft-tissue infection without osteomyelitis, and 4 had no infection. The best interpretation criterion for osteomyelitis with WBC scintigraphy was a target-to-background (T/B) ratio greater than 2.0 at 20 h and increasing with time. A T/B ratio greater than 2.0 at 20 h but stable or decreasing with time was suggestive of soft-tissue infection. A T/B ratio of no more than 2.0 at 20 h excluded an infection. Thus, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for osteomyelitis were 86%, 100%, 100%, 86%, and 92%, respectively. For F-18-FDG PET/CT, the best interpretation criterion for osteomyelitis was a maximal standardized uptake value (SUVmax) greater than 2.0 at 1 and 2 h and increasing with time. A SUVmax greater than 2.0 after 1 and 2 h but stable or decreasing with time was suggestive of a soft-tissue infection. An SUVmax less than 2.0 excluded an infection. F-18-FDG PET at 10 min was not useful. Using these criteria, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for osteomyelitis were 43%, 67%, 60%, 50%, and 54%, respectively. Combining visual assessment of PET at 1 h and CT was best for differentiating between osteomyelitis and soft-tissue infection, with a diagnostic accuracy of 62%. Conclusion: F-18-FDG PET/CT, even with sequential imaging, has a low diagnostic accuracy for osteo-myelitis and cannot replace WBC scintigraphy in patients with diabetic foot. |
| Databáze: | OpenAIRE |
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