Is FDG-PET A Better Imaging Option For Diabetic Osteomyelitis?
Keidar and colleagues studied osteomyelitis in 18 suspected infection sites in 14 patients with diabetes, and used FDG-PET/CT.17 The PET scans alone may not be able to clearly identify the location of an area of increased 18F-FDG uptake. The FDG-PET/CT is a hybrid technology that combines the sensitivity of PET with the ability of CT to determine the exact anatomic location of infections.18
Keidar and co-workers found that FDG-PET/CT was able to correctly differentiate osteomyelitis from soft tissue infections in all sites.17 The complicated diabetic foot is a specific scenario that may benefit substantially from hybrid imaging modalities. The use of these combined techniques will lead to the avoidance of unnecessary and expensive invasive procedures.19
Although MRI and nuclear medicine scans are effective modalities for diagnosing osteomyelitis, recent studies have proven that PET scans are more effective in accurately diagnosing osteomyelitis. In their meta-analysis, Termaat and colleagues concluded that further studies, including randomized clinical trials, are needed to assess the true ability of FDG-PET scan to diagnose osteomyelitis.5
Despite promising results from these studies, FDG-PET is still not being utilized routinely in clinical practice. Its high cost and limited availability prevent its widespread use in diagnosing osteomyelitis. In the future, FDG-PET may be especially useful in helping to diagnose osteomyelitis in patients with diabetes whose conditions are complicated by Charcot neuroarthropathy.
The authors acknowledge Gavin Duke, MD, who is affiliated with East River Medical Imaging in New York City, for generously allowing them to view his PET/CT images. They also thank Anthony Iorio, DPM, Assistant Dean for Continuing Medical Education at the New York College of Podiatric Medicine, for his help in obtaining the PET/CT images and fourth-year student John Schwerdt for his help in researching the topic.
Ms. Markowitz is a third-year student at the New York College of Podiatric Medicine.
Mr. Kantor is a third-year student at the New York College of Podiatric Medicine.
Dr. Cohen is a Professor and Director in the Radiology Section in the Department of Medical Sciences at the New York College of Podiatric Medicine.
Dr. Khan is an Assistant Professor in the Department of Medical Sciences at the New York College of Podiatric Medicine. He is an Associate of the American College of Foot and Ankle Surgeons, and a Fellow of the American Professional Wound Care Association.
Dr. Steinberg is an Assistant Professor in the Department of Plastic Surgery at the Georgetown University School of Medicine in Washington, D.C. Dr. Steinberg is a Fellow of the American College of Foot and Ankle Surgeons.