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

Zohar Keidar, MD, PhD1,2, Daniela Militianu, MD3, Eyal Melamed, MD4, Rachel Bar-Shalom, MD1 and Ora Israel, MD1,2

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



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  		FIGURE 1. PET/CT-based diagnosis of osteomyelitis complicating diabetic foot in 50-y-old man with nonhealing wound in right forefoot. (A and B) 18F-FDG PET coronal (A) and transaxial (B) images show area of increased 18F-FDG uptake in lateral aspect of forefoot. (C) PET/CT localizes abnormal 18F-FDG uptake to head of fourth metatarsus. (D) CT shows normal bone structure in corresponding area. Osteomyelitis was further confirmed by histopathologic examination of tissue samples obtained at surgery.

 


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  		FIGURE 2. PET/CT-based exclusion of osteomyelitis and localization of infection to soft-tissue abscess in 43-y-old woman with nonhealing ulcer and cellulitis in lateral aspect of right foot. (A and B) 18F-FDG PET coronal (A) and transaxial (B) images show area of increased 18F-FDG uptake in lateral aspect of mid foot. (C) PET/CT localizes abnormal 18F-FDG uptake to soft tissues. (D) CT shows soft-tissue swelling in same area. Patient underwent local drainage and short course of antimicrobial therapy with good clinical response. No evidence of osteomyelitis was found during a clinical and imaging follow-up of 12 mo.

 




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