Remedios D, Valabhji J, Oelbaum R, Sharp P, Mitchell R
Department of Clinical Radiology, Northwick Park Hospital, Harrow, Middlesex, UK.
Clin Radiol. 1998 Feb;53(2):120-5. doi: 10.1016/s0009-9260(98)80058-5.
Distinguishing osteomyelitis from neuropathic osteoarthropathy in diabetic feet is a common and difficult clinical problem with no highly accurate discriminatory investigation. This study assesses the novel use of marrow scintigraphy and compares it with magnetic resonance imaging (MRI) for the diagnosis of osteomyelitis in neuropathic osteoarthropathic diabetic feet. Nine diabetic patients with chronic foot ulcers were prospectively assessed independently using 99mTc-nanocolloid scintigraphy and MRI. Those patients showing features of osteomyelitis underwent percutaneous bone biopsy or surgical ray excision for histological confirmation. Other patients were followed up clinically for a minimum of 6 months to exclude osteomyelitis. Marrow scintigraphy, in agreement with MRI, demonstrated all four cases of biopsy proven osteomyelitis and excluded three cases with neuropathic osteoarthropathy alone. One case of suspected osteomyelitis of the ankle on marrow scintigraphy, but not MRI, was not confirmed clinically. One case of suspected osteomyelitis on both imaging modalities was shown on biopsy to demonstrate changes of avascular necrosis but not osteomyelitis. In this study 99mTc-nanocolloid scintigraphy shows a sensitivity of 100% and specificity of 60%. An important false positive result is seen with avascular necrosis, both on marrow scintigraphy and on MRI. Although larger studies are needed to evaluate this technique, 99mTc-nanocolloid marrow scintigraphy may be an alternative to MRI for assessing diabetic feet for osteomyelitis.
区分糖尿病足中的骨髓炎和神经性骨关节病是一个常见且棘手的临床问题，目前尚无高度准确的鉴别检查方法。本研究评估了骨髓闪烁显像的新用途，并将其与磁共振成像（MRI）用于诊断神经性骨关节病性糖尿病足中的骨髓炎进行比较。对9例患有慢性足部溃疡的糖尿病患者分别前瞻性地独立采用99mTc-纳米胶体闪烁显像和MRI进行评估。那些表现出骨髓炎特征的患者接受经皮骨活检或手术切除射线进行组织学确诊。其他患者进行至少6个月的临床随访以排除骨髓炎。骨髓闪烁显像与MRI一致，显示出所有4例经活检证实的骨髓炎病例，并排除了3例仅患有神经性骨关节病的病例。1例骨髓闪烁显像怀疑踝关节骨髓炎但MRI未显示的病例，临床未得到证实。两种成像方式均怀疑骨髓炎的1例病例，活检显示为无血管坏死改变而非骨髓炎。在本研究中，99mTc-纳米胶体闪烁显像的敏感性为100%，特异性为60%。在骨髓闪烁显像和MRI上，无血管坏死均出现重要的假阳性结果。尽管需要更大规模的研究来评估该技术，但99mTc-纳米胶体骨髓闪烁显像可能是用于评估糖尿病足骨髓炎的MRI替代方法。
