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  IMAGING INFECTION 

The Quarterly Journal of Nuclear Medicine 1999 March;43(1):9-20

Copyright © 2000 EDIZIONI MINERVA MEDICA

lingua: Inglese

Imaging osteomyelitis and the diabetic foot

Becker W.

From the Department of Nuclear Medicine University of Göttingen, Germany


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Background. The clin­i­cal diag­no­sis of osteo­my­e­li­tis and the dia­bet­ic ­foot is in ­most of the ­patients not pos­sible with­out imag­ing the ­bone. The clin­i­cal prob­lem is to diag­nose infec­tion as ear­ly, as reli­able and as ­cheap as pos­sible to pre­vent the pos­sible long­stand­ing and ­life-threat­en­ing com­pli­ca­tions.
Methods. For imag­ing a lot of dif­fer­ent radio­log­i­cal and nucle­ar med­i­cine meth­ods are avail­able. This arti­cle focus­es on the pos­sible ­results of con­ven­tion­al ­plain radiog­ra­phy and tomog­ra­phy, com­put­ed tomog­ra­phy and mag­net­ic res­o­nance imaging as radio­log­i­cal meth­ods and on ­bone ­scan, autol­o­gous ­white ­blood ­cell scin­tig­ra­phy ­with 111In-­oxin or 99mTc-­HMPAO, anti­gra­nu­lo­cyte anti­bod­ies, 99mTc-/111In-­human immu­no­glob­u­lin, 67Ga-cit­rate and 99mTc-nano­col­loids.
Results. Different meth­ods ­offer dif­fer­ent ­answers. Radiological meth­ods ­give ­detailed path­o­log­i­cal ­answers, nucle­ar med­i­cine meth­ods ­answer ques­tions of spec­i­fic­ity ­such as leu­ko­cyt­ic infil­tra­tion.
Conclusions. If osteo­my­e­li­tis is sus­pect­ed, ­plain radiog­ra­phy ­should be the ­first, ­three ­phase ­bone scin­tig­ra­phy the sec­ond and infec­tion spe­cif­ic radio­phar­ma­ceu­ti­cals the ­third ­step of exam­ina­tion. Only in neg­a­tive imag­es ­with ­high clin­i­cal sus­pi­cion CT or MRI ­should be the ­final imag­ing pro­ce­dure. In the dia­bet­ic ­foot imag­ing cas­cade ­should ­also ­start ­with ­plain radiog­ra­phy, fol­lowed by ­three ­phase ­bone scin­tig­ra­phy or MRI. If clin­i­cal­ly neu­rop­a­thy is ­present spe­cif­ic nucle­ar med­i­cine imag­ing should be per­formed.

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