Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
Nuclear Medicine Unit, Faculty of Medicine and Psychology, Department of Medical-Surgical Sciences and of Translational Medicine, Sapienza University of Rome, Rome, Italy.
Diabetes Care. 2017 Aug;40(8):1111-1120. doi: 10.2337/dc17-0532.
Diagnosing bone infection in the diabetic foot is challenging and often requires several diagnostic procedures, including advanced imaging. We compared the diagnostic performances of MRI, radiolabeled white blood cell (WBC) scintigraphy (either with Tc-hexamethylpropyleneamineoxime [HMPAO] or In-oxine), and [F]fluorodeoxyglucose positron emission tomography (F-FDG-PET)/computed tomography.
We searched Medline and Embase as of August 2016 for studies of diagnostic tests on patients known or suspected to have diabetes and a foot infection. We performed a systematic review using criteria recommended by the Cochrane Review of a database that included prospective and retrospective diagnostic studies performed on patients with diabetes in whom there was a clinical suspicion of osteomyelitis of the foot. The preferred reference standard was bone biopsy and subsequent pathological (or microbiological) examination.
Our review found 6,649 articles; 3,894 in Medline and 2,755 in Embase. A total of 27 full articles and 2 posters was selected for inclusion in the analysis. The performance characteristics for the F-FDG-PET were: sensitivity, 89%; specificity, 92%; diagnostic odds ratio (DOR), 95; positive likelihood ratio (LR), 11; and negative LR, 0.11. For WBC scan with In-oxine, the values were: sensitivity, 92%; specificity, 75%; DOR, 34; positive LR, 3.6; and negative LR, 0.1. For WBC scan with Tc-HMPAO, the values were: sensitivity, 91%; specificity, 92%; DOR, 118; positive LR, 12; and negative LR, 0.1. Finally, for MRI, the values were: sensitivity, 93%; specificity, 75%; DOR, 37; positive LR, 3.66, and negative LR, 0.10.
The various modalities have similar sensitivity, but F-FDG-PET and Tc-HMPAO-labeled WBC scintigraphy offer the highest specificity. Larger prospective studies with a direct comparison among the different imaging techniques are required.
诊断糖尿病足的骨感染具有挑战性，通常需要进行几种诊断程序，包括高级影像学检查。我们比较了 MRI、放射性标记白细胞（WBC）闪烁扫描（使用 Tc-六甲基丙烯胺肟[HMPAO]或 In-oxine）和 [F]氟脱氧葡萄糖正电子发射断层扫描（F-FDG-PET）/计算机断层扫描的诊断性能。
我们截至 2016 年 8 月在 Medline 和 Embase 上搜索了已知或疑似患有糖尿病和足部感染的患者的诊断测试研究。我们使用 Cochrane 评价数据库中推荐的标准进行了系统评价，该数据库包括对糖尿病患者进行的前瞻性和回顾性诊断研究，这些患者有足部骨髓炎的临床怀疑。首选参考标准是骨活检和随后的病理（或微生物学）检查。
我们的综述发现了 6649 篇文章；Medline 中有 3894 篇，Embase 中有 2755 篇。共有 27 篇全文文章和 2 篇海报被选入分析。F-FDG-PET 的性能特征为：敏感性为 89%；特异性为 92%；诊断比值比（DOR）为 95；阳性似然比（LR）为 11；阴性似然比（LR）为 0.11。对于 In-oxine 标记的 WBC 扫描，值为：敏感性为 92%；特异性为 75%；DOR 为 34；阳性 LR 为 3.6；阴性 LR 为 0.1。对于 Tc-HMPAO 标记的 WBC 扫描，值为：敏感性为 91%；特异性为 92%；DOR 为 118；阳性 LR 为 12；阴性 LR 为 0.1。最后，对于 MRI，值为：敏感性为 93%；特异性为 75%；DOR 为 37；阳性 LR 为 3.66，阴性 LR 为 0.10。
各种方法的敏感性相似，但 F-FDG-PET 和 Tc-HMPAO 标记的 WBC 闪烁扫描具有最高的特异性。需要进行更大规模的前瞻性研究，以直接比较不同的成像技术。
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