Lauri Chiara, Glaudemans Andor W J M, Campagna Giuseppe, Keidar Zohar, Muchnik Kurash Marina, Georga Stamata, Arsos Georgios, Noriega-Álvarez Edel, Argento Giuseppe, Kwee Thomas C, Slart Riemer H J A, Signore Alberto
Nuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, "Sapienza" University of Rome, 00161 Rome, Italy.
Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, 9700 Groningen, The Netherlands.
J Clin Med. 2020 May 30;9(6):1645. doi: 10.3390/jcm9061645.
Diabetic foot infections (DFIs) represent one of the most frequent and disabling morbidities of longstanding diabetes; therefore, early diagnosis is mandatory. The aim of this multicenter retrospective study was to compare the diagnostic accuracy of white blood cell scintigraphy (WBC), F-fluorodeoxyglucose positron emission tomography/computed tomography ((F) FDG PET/CT), and Magnetic Resonance Imaging (MRI) in patients with suspected DFI. Images and clinical data from 251 patients enrolled by five centers were collected in order to calculate the sensitivity, specificity, and accuracy of WBC, FDG, and MRI in diagnosing osteomyelitis (OM), soft-tissue infection (STI), and Charcot osteoarthropathy. In OM, WBC acquired following the European Society of Nuclear Medicine (EANM) guidelines was more specific and accurate than MRI (91.9% vs. 70.7%, < 0.0001 and 86.2% vs. 67.1%, = 0.003, respectively). In STI, both FDG and WBC achieved a significantly higher specificity than MRI (97.9% and 95.7% vs. 83.6%, = 0.04 and = 0.018, respectively). In Charcot, both MRI and WBC demonstrated a significantly higher specificity and accuracy than FDG (88.2% and 89.3% vs. 62.5%, = 0.0009; 80.3% and 87.9% vs. 62.1%, < 0.02, respectively). Moreover, in Charcot, WBC was more specific than MRI (89.3% vs. 88.2% < 0.0001). Given the limitations of a retrospective study, WBC using EANM guidelines was shown to be the most reliable imaging modality to differentiate between OM, STI, and Charcot in patients with suspected DFI.
糖尿病足感染（DFIs）是长期糖尿病最常见且致残的并发症之一；因此，早期诊断至关重要。这项多中心回顾性研究的目的是比较白细胞闪烁扫描（WBC）、氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（（F）FDG PET/CT）和磁共振成像（MRI）对疑似DFI患者的诊断准确性。收集了五个中心登记的251例患者的图像和临床数据，以计算WBC、FDG和MRI在诊断骨髓炎（OM）、软组织感染（STI）和夏科氏骨关节病方面的敏感性、特异性和准确性。在OM中，按照欧洲核医学协会（EANM）指南进行的WBC检查比MRI更具特异性和准确性（分别为91.9%对70.7%，<0.0001；86.2%对67.1%，=0.003）。在STI中，FDG和WBC的特异性均显著高于MRI（分别为97.9%和95.7%对83.6%，=0.04和=0.018）。在夏科氏病中，MRI和WBC的特异性和准确性均显著高于FDG（分别为88.2%和89.3%对62.5%，=0.0009；80.3%和87.9%对62.1%，<0.02）。此外，在夏科氏病中，WBC比MRI更具特异性（89.3%对88.2%，<0.0001）。鉴于回顾性研究的局限性，采用EANM指南的WBC被证明是区分疑似DFI患者的OM、STI和夏科氏病的最可靠成像方式。
