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The Diabetic Foot: Initial Experience with ¹⁸F-FDG PET/CT

¹ Department of Nuclear Medicine, Rambam Medical Center, Haifa, Israel
² School of Medicine, Technion–Israel Institute of Technology, Technion City, Haifa, Israel
³ Department of Diagnostic Radiology, Rambam Medical Center, Haifa, Israel
⁴ Department of Orthopedics, Rambam Medical Center, Haifa, Israel

Osteomyelitis complicates up to one third of diabetic foot infections, is often due to direct contamination from a soft-tissue lesion, and represents a clinical challenge. Early diagnosis is important since antibiotic therapy can be curative and may prevent amputation. The present study assessed the role of PET/CT using ¹⁸F-FDG for the diagnosis of diabetic foot osteomyelitis. Methods: Fourteen diabetic patients (10 men and 4 women; age range, 29–70 y) with 18 clinically suspected sites of infection underwent PET/CT after the injection of 185–370 MBq of ¹⁸F-FDG for suspected osteomyelitis complicating diabetic foot disease. PET, CT, and hybrid images were independently evaluated for the diagnosis and localization of an infectious process. Additional data provided by PET/CT for localization of infection in the bone or soft tissues were recorded. The final diagnosis was based on histopathologic findings and bacteriologic assays obtained at surgery or at clinical and imaging follow-up. Results: PET detected 14 foci of increased ¹⁸F-FDG uptake suspected as infection in 10 patients. PET/CT correctly localized 8 foci in 4 patients to bone, indicating osteomyelitis. PET/CT correctly excluded osteomyelitis in 5 foci in 5 patients, with the abnormal ¹⁸F-FDG uptake limited to infected soft tissues only. One site of mildly increased focal ¹⁸F-FDG uptake was localized by PET/CT to diabetic osteoarthropathy changes demonstrated on CT. Four patients showed no abnormally increased ¹⁸F-FDG uptake and no further evidence of an infectious process on clinical and imaging follow-up. Conclusion: ¹⁸F-FDG PET can be used for diagnosis of diabetes-related infection. The precise anatomic localization of increased ¹⁸F-FDG uptake provided by PET/CT enables accurate differentiation between osteomyelitis and soft-tissue infection.

Key Words: PET/CT • infection • diabetic foot

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