Przybylski Mallory M, Holloway Samantha, Vyce Steven D, Obando Antonio
Podiatric Surgery and Medicine, VA Healthcare system/Yale New Haven Hospital, West Haven, CT, USA.
Institute for Translation, Innovation, Methodologies and Engagement, Cardiff University School of Medicine, Cardiff, UK.
Int Wound J. 2016 Jun;13(3):382-9. doi: 10.1111/iwj.12316. Epub 2014 Jun 26.
Diabetic foot ulceration poses a significant threat of osteomyelitis (OM) and subsequent amputation. The diagnosis of OM via imaging studies is difficult as radiographic findings do not present immediately and advanced imaging studies may be contraindicated or unavailable. A novel diagnostic tool has been developed which synthesises technetium-99 white blood cell-labelled single-photon emission computed tomography and computed tomography (Tc(99m) WBC labelled-SPECT/CT) imaging, effectively enhancing anatomic detail. The aim of this pilot study was to determine the validity and reliability of this novel imaging technique in patients with diabetic foot ulcers in a Veterans Affairs healthcare facility. A retrospective review was performed on consecutive patients who met the inclusion criteria (n = 14) and underwent Tc(99m) WBC-labelled SPECT/CT for suspected OM. Histopathologic analysis of bone specimen (when available) and International Working Group on the Diabetic Foot consensus criteria were used as a reference standard. The sensitivity and specificity of Tc(99m) WBC-labelled SPECT/CT were 87·50% [confidence interval (CI): 64·58-110·42%] and 71·43% (CI: 37·96-104·90%), respectively. Negative predictive value (NPV) and positive predictive value (PPV) were 83·33% (CI: 53·51-113·15%) and 77·78% (CI: 50·62-104·94%), respectively, with a likelihood ratio (LR) of 3·063 and an accuracy of 80%. These findings suggest Tc(99m) WBC-labelled SPECT/CT can be useful in imaging OM in patients with diabetic foot ulcers.
糖尿病足溃疡对骨髓炎（OM）及随后的截肢构成重大威胁。通过影像学检查诊断OM很困难，因为X线表现不会立即出现，而先进的影像学检查可能存在禁忌或无法进行。已开发出一种新型诊断工具，它将锝-99白细胞标记的单光子发射计算机断层扫描和计算机断层扫描（Tc(99m) WBC标记的SPECT/CT）成像相结合，有效增强了解剖细节。这项初步研究的目的是确定这种新型成像技术在退伍军人事务医疗设施中糖尿病足溃疡患者中的有效性和可靠性。对符合纳入标准的连续患者（n = 14）进行了回顾性研究，这些患者因疑似OM接受了Tc(99m) WBC标记的SPECT/CT检查。骨标本的组织病理学分析（如有）和糖尿病足国际工作组的共识标准被用作参考标准。Tc(99m) WBC标记的SPECT/CT的敏感性和特异性分别为87.50% [置信区间（CI）：64.58 - 110.42%]和71.43%（CI：37.96 - 104.90%）。阴性预测值（NPV）和阳性预测值（PPV）分别为83.33%（CI：53.51 - 113.15%）和77.78%（CI：50.62 - 104.94%），似然比（LR）为3.063，准确率为80%。这些发现表明，Tc(99m) WBC标记的SPECT/CT可用于糖尿病足溃疡患者OM的成像。
