In a study headed by Dr. Zohar Keidar, MD, PhD, physicians from the Rambam Medical Center in Haifa, Israel, demonstrated that a single, non-invasive test using combined PET/CT imaging can effectively diagnose localized osteomyelitis adjacent to soft tissue infection in the diabetic foot. The team presented the findings of its study at the Society of Nuclear Medicine's 51st Annual Meeting in Philadelphia.
Diabetes can reduce circulation in the extremities. Poor circulation, combined with the reduced ability to fight off even minor infections, puts diabetics at risk for development of chronic bone infection, which can lead to one of the most feared consequences of diabetes--amputation of the afflicted foot. Because antibiotic therapy can cure these bone infections if administered in time, early detection of infection is critical.
"Diabetes is a frightening, often lifelong battle. Amputation of the foot or leg is probably the scariest potential risk that most sufferers face," said Dr. Keidar.
For the study, the researchers evaluated patients with suspected osteomyelitis using PET/CT fusion imaging and the radiotracer 18F-FDG. The diagnoses made by PET/CT experts were later compared with the definitive diagnoses obtained at surgery or through clinical follow-up. PET/CT correctly identified osteomyelitis in 5 patients, non-bone infection in 3 and no infection in the remaining patients. Diagnosis using combined imaging resulted in far fewer false positive diagnoses--cases in which the physician believed chronic infection was present when it was not than diagnosis with CT alone.
The new technique makes use of the latest generation of hybrid scanners. The PET/CT scanner combines information from positron emission tomography (PET) with a three-dimensional X-ray study (the computed tomography or CT part). PET images tissues that are more metabolically active, such as those fighting infection, while CT provides anatomical information. The resulting fused images provide a precise picture of where any unusually metabolically active tissue is located.
"If we can detect the precise location of infection, the treatment strategy will be easier to define," commented Dr. Keidar. "Our study shows how advances in imaging technology can directly affect patient care and make a big difference for patients with complications of diabetes foot."
The Society of Nuclear Medicine is holding its 51st Annual Meeting June 19–23, 2004, at the Pennsylvania Convention Center in downtown Philadelphia. Hot topics for the 2004 meeting include techniques for the early diagnosis of Alzheimer's disease; advanced imaging for the diagnosis, staging, and treatment of cancer; nuclear cardiology; and the collaboration between nuclear medicine and bioengineering in the fight against cancer.