Research ArticleCLINICAL INVESTIGATIONS

Diabetic Foot Infection: Usefulness of SPECT/CT for 99mTc-HMPAO-Labeled Leukocyte Imaging

Luca Filippi, Luigi Uccioli, Laura Giurato and Orazio Schillaci
Journal of Nuclear Medicine July 2009, 50 (7) 1042-1046; DOI: https://doi.org/10.2967/jnumed.108.059493

Article Figures & Data

Figures

  • FIGURE 1. 
    FIGURE 1. 

    SPECT/CT-based exclusion of osteomyelitis in 55-y-old patient with nonhealing ulcer and cellulitis in right mid foot. (A) Planar images showed area of increased uptake strongly suggestive of osteomyelitis. (B) SPECT/CT allowed localization of infection (violet area in superimposition images) to soft tissues (arrow). No evidence of osteomyelitis was found at histopathologic diagnosis.

Tables

  • TABLE 1

    Results of Labeled Leukocyte Scintigraphy (Planar plus SPECT) and SPECT/CT: Data on 15 Patients with Suspected Diabetic Foot Infection and Positive Scan Findings

    Patient no.Location of ulcerClinical featuresSuspected infectionPlanar plus SPECT findingsSPECT/CT findingsSPECT/CT clinical contributionFinal diagnosis
    1First toe, LUlcer, foot pain, feverOMInfection in toe (OM)STIExclusion of OMSTI* (FU)
    2Mid foot, RFoot pain, edema, ulcerOM and STIInfection in metatarsus and neighboring soft tissue (OM and STI)STIExclusion of OMSTI* (B/C = S. aureus, FU)
    3†Calcaneus, R; forefoot, RUlcers, pain, edemaOMInfection in calcaneus and metatarsus (OM)STI in both sitesExclusion of OMSTI* (B/C = S. aureus, FU); STI* (B/C = S. aureus, FU)
    4Calcaneus, RNonhealing wound, pain, feverOMInfection in calcaneus (OM)OM and STI in calcaneusDefining extent of diseaseOM and STI (B/C = PA, FU)
    5Metatarsus, RNonhealing wound, pain, edemaOMInfection in metatarsus (OM)OM in first metatarsusNot significantOM (B/C = PA, FU)
    6First toe, RUlcer, fever, painSTIInfection in soft tissue (STI)OM and STIDefining extent of diseaseOM and STI (B/C = PA, FU)
    7Metatarsus, LFoot pain, edema, cellulitis, ulcerSTIInfection in soft tissue (STI)STINot significantSTI* (FU)
    8†Calcaneus, R; metatarsus, RUlcers, pain, edema, feverOMInfection in calcaneus (OM) and metatarsus (OM)STI in calcaneus and OM in metatarsusNot significant (OM in metatarsus), excluding OM in calcaneusOM (B/C = PA, FU); STI* (B/C = PA, FU)
    9Metatarsus, LFoot pain, ulcer, edemaOMInfection in metatarsus, location uncertain (OM vs. STI)STI in metatarsusExclusion of OMSTI* (B/C = S. pyogenes, FU)
    10Hind foot, LNonhealing wound, foot pain, edemaSTIInfection in soft tissue of the external aspect of hindfoot (STI)OM of the external malleolusDiagnosis is OMOM (B/C = PA, FU)
    11Fourth toe, LFever, edema, nonhealing woundOMInfection in toe (OM)OMNo significant contributionOM (FU)‡
    12Metatarsus, LUlcer, fever, cellulitisOMInfection in metatarsal soft tissue (STI)OM and STIDefining extent of diseaseOM and STI (B/C = PA, FU)
    13Calcaneus, RUlcer, foot pain, edemaOMInfection in calcaneus (OM)STIExclusion of OMSTI* (B/C = S. aureus, FU)
    14Second toe, RUlcer, edema, feverOMInfection in toe (OM)OMNot significantOM (FU)‡
    15First toe, LEdema, nonhealing woundSTINo infectionNo infectionNot significantCharcot foot (FU: typical bone alterations at MRI)§
    16Hind foot, RNonhealing woundSTINo infectionNo infectionNot significantIschemic ulcer (B/C = no infection, FU)§
    17Fifth toeNonhealing wound, painOMNo infectionNo infectionNot significantIschemic ulcer (B/C = no infection, FU)§

    • ↵* All cases treated for STI with adequate clinical response during FU.

    • ↵† Same patient, 2 sites of infection.

    • ↵‡ Clinical observation and serial radiologic studies showing bone alterations typical of osteomyelitis.

    • ↵§ All patients were free from infection at FU.

    • OM = osteomyelitis; STI = soft-tissue infection; FU = follow-up; B/C = biopsy and bacteriologic cultures; PA = polymicrobial agents.

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