Diagnosis of infection in the diabetic foot using ¹⁸F‐FDG PET/CT: a sweet alternative?

Excerpt

Accurate diagnosis and management of skeletal infection is crucial and challenging. The goals of imaging in infection are (a) to establish an early and reliable diagnosis, as clinical and laboratory markers are often nonspecific in the early stages, (b) to localize, characterize and define the extent of involvement (often influences or directs diagnostic and/or therapeutic intervention), and (c) to assess treatment response [1]. Such considerations are particularly important in several select groups of patients such as diabetics, who are relatively more prone to cutaneous ulceration and its related complications. Approximately 2 million cases of musculoskeletal infection are diagnosed each year in the USA [2] and MRI is the most commonly used imaging modality. MRI with gadolinium contrast enhancement is useful (a) in differentiating abscess from inflammatory tissue, (b) to differentiate viable from nonviable tissue, and (c) to evaluate bone involvement [1]. However, the presence of preexisting renal impairment is a potentially major limitation in the use of MRI with gadolinium contrast enhancement. Metal artefacts may obscure underlying pathology, if there has been previous intervention [1] and it may be difficult to distinguish osteomyelitis from Charcot’s neuroarthropathy in the diabetic foot using MRI alone. …