News | June 19, 2013

Dual Agent Scan Differentiates Diabetic Foot Disorders

Novel approach to a molecular imaging technique helps doctors identify diabetic foot infection and rule out a non-infectious complication that develops in nerve-damaged joints

June 19, 2013 — By targeting both bone cell activity and immune response and improving imaging data interpretation, doctors can better distinguish diabetic foot infection from another common foot condition that often requires an additional bone-marrow scan for definitive diagnosis, say researchers presenting a study at the Society of Nuclear Medicine and Molecular Imaging’s 2013 Annual Meeting.

This study reveals that with enhanced visual and data analysis of standard hybrid nuclear imaging that combines agents targeting bone cell activity and white blood cell immune response, physicians can accurately diagnose diabetic foot disorders and avoid second-day bone marrow imaging.

“Optimizing imaging protocol for detection and localization of diabetic foot conditions aids attending physicians in distinguishing between true bone infection and bone marrow overgrowth associated with Charcot joint,” says Sherif Heiba, M.D., director of nuclear medicine residency program and associate professor of radiology at Mount Sinai School of Medicine, New York, N.Y. “This helps patients considerably by not only eliminating unnecessary scans but also reducing imaging time and the total radiation dose required to make that determination.”

In this study, researchers investigated new data analysis for single photon emission computed tomography (SPECT) and computed tomography (CT), which together provide both biological and anatomical information about diabetic food disorders. The combination of imaging agents technetium-99m hydroxymethylene diphosphonate (HDP) — an expert biomarker for targeting bone — and a white blood cell or leukocyte biomarker that seeks out hot spots of infection can provide new comparative imaging data that make accurate diagnosis possible with a single scan.

A total of 22 diabetic patients were imaged with dual-isotope SPECT/CT for suspected diabetic foot infection. Scanning detected 27 lesions, 10 of which were confirmed as osteomyelitis. Osteomyelitis correlated with adjacent deep soft tissue infection in white blood cell SPECT/CT scan in nine of the 10 lesions. Researchers also analyzed patterns of wash-out of the white blood cell imaging agent to differentiate actual osteomyelitis from Charcot joint. Initial scans for 15 of the 17 lesions that were confirmed to represent Charcot joints showed white blood cell wash-out. Results were confirmed by an additional bone marrow scan, proving that dual-isotope bone and white blood cell SPECT/CT scan can positively identify osteomyelitis from Charcot joint without an additional bone marrow scan.

For more information: www.snmmi.org

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