Abstract
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Objectives Foot ulcer & infection suspicion is one of the most common hospitalization causes & a major source of morbidity & resource use for diabetic patients (dpts). Many dpts will require foot or above ankle amputation; yet, major amputation is associated with alarmingly high 5-year mortality. In this study, we assess diagnosis & management of dpts with dual isotope (DI) SPECT/CT use as compared to conventional imaging (CI).
Methods Step1 DI (Tc-99m-HDP/In-111 WBC) SPECT/CT foot imaging was performed on all dpts, & if needed (focal uptake in mid/hind foot on both bone/WBC) step2 DI (Tc-99m sulfur colloid/In-111 WBC) SPECT/CT was obtained the following day. The management of 227 dpts who had DI SPECT/CT was compared to 232 similar (age, sex) dpts who had CI (137 plain x-ray, 13 CT, 93 planar bone scan, 8 planar In-111 WBC & 23 MRI). Dpts with ischemia/gangrene only (13 in DI SPECT & 18 in CI groups) were excluded.
Results Final diagnosis categories: soft tissue infection (STI), osteomyelitis (OM) with/without (w/wo) STI, & other pathology confirmed by culture/pathology or follow up were more accurately identified in DI SPECT/CT than CI groups (Lambda 0.94 ± 0.02 & 0.37 ± 0.06, respectively). Table 1 compares surgical procedures & conservative management between groups as well as hospital stay in dpts without other contributing comorbidities.
Conclusions In this large dpts population with suspected foot infection DI SPECT/CT was more accurate in diagnosing & localizing infection than CI. Additionally, DI SPECT/CT provided clear guidance & promoted many limb salvage procedures. Of equal importance to health economics, DI SPECT/CT use was associated with considerably reduced length of hospitalization than CI
NS=not significant, SD=standard deviation
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