Patient no. | Location of ulcer | Clinical features | Suspected infection | Planar plus SPECT findings | SPECT/CT findings | SPECT/CT clinical contribution | Final diagnosis |
---|---|---|---|---|---|---|---|
1 | First toe, L | Ulcer, foot pain, fever | OM | Infection in toe (OM) | STI | Exclusion of OM | STI* (FU) |
2 | Mid foot, R | Foot pain, edema, ulcer | OM and STI | Infection in metatarsus and neighboring soft tissue (OM and STI) | STI | Exclusion of OM | STI* (B/C = S. aureus, FU) |
3† | Calcaneus, R; forefoot, R | Ulcers, pain, edema | OM | Infection in calcaneus and metatarsus (OM) | STI in both sites | Exclusion of OM | STI* (B/C = S. aureus, FU); STI* (B/C = S. aureus, FU) |
4 | Calcaneus, R | Nonhealing wound, pain, fever | OM | Infection in calcaneus (OM) | OM and STI in calcaneus | Defining extent of disease | OM and STI (B/C = PA, FU) |
5 | Metatarsus, R | Nonhealing wound, pain, edema | OM | Infection in metatarsus (OM) | OM in first metatarsus | Not significant | OM (B/C = PA, FU) |
6 | First toe, R | Ulcer, fever, pain | STI | Infection in soft tissue (STI) | OM and STI | Defining extent of disease | OM and STI (B/C = PA, FU) |
7 | Metatarsus, L | Foot pain, edema, cellulitis, ulcer | STI | Infection in soft tissue (STI) | STI | Not significant | STI* (FU) |
8† | Calcaneus, R; metatarsus, R | Ulcers, pain, edema, fever | OM | Infection in calcaneus (OM) and metatarsus (OM) | STI in calcaneus and OM in metatarsus | Not significant (OM in metatarsus), excluding OM in calcaneus | OM (B/C = PA, FU); STI* (B/C = PA, FU) |
9 | Metatarsus, L | Foot pain, ulcer, edema | OM | Infection in metatarsus, location uncertain (OM vs. STI) | STI in metatarsus | Exclusion of OM | STI* (B/C = S. pyogenes, FU) |
10 | Hind foot, L | Nonhealing wound, foot pain, edema | STI | Infection in soft tissue of the external aspect of hindfoot (STI) | OM of the external malleolus | Diagnosis is OM | OM (B/C = PA, FU) |
11 | Fourth toe, L | Fever, edema, nonhealing wound | OM | Infection in toe (OM) | OM | No significant contribution | OM (FU)‡ |
12 | Metatarsus, L | Ulcer, fever, cellulitis | OM | Infection in metatarsal soft tissue (STI) | OM and STI | Defining extent of disease | OM and STI (B/C = PA, FU) |
13 | Calcaneus, R | Ulcer, foot pain, edema | OM | Infection in calcaneus (OM) | STI | Exclusion of OM | STI* (B/C = S. aureus, FU) |
14 | Second toe, R | Ulcer, edema, fever | OM | Infection in toe (OM) | OM | Not significant | OM (FU)‡ |
15 | First toe, L | Edema, nonhealing wound | STI | No infection | No infection | Not significant | Charcot foot (FU: typical bone alterations at MRI)§ |
16 | Hind foot, R | Nonhealing wound | STI | No infection | No infection | Not significant | Ischemic ulcer (B/C = no infection, FU)§ |
17 | Fifth toe | Nonhealing wound, pain | OM | No infection | No infection | Not significant | Ischemic 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.