Magnetic Resonance Imaging and 99Tc WBC-SPECT/CT Scanning in Differential Diagnosis between Osteomyelitis and Charcot Neuroarthropathy: A Case Series.

IF 2.2 4区医学 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Tomography Pub Date : 2024-08-22 DOI:10.3390/tomography10080098

Sara Cecchini, Cristina Gatti, Daniela Fornarelli, Lorenzo Fantechi, Cinzia Romagnolo, Elena Tortato, Anna Rita Bonfigli, Roberta Galeazzi, Fabiola Olivieri, Giuseppe Bronte, Enrico Paci

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Abstract

Background: Distinguishing between Charcot Neuroarthropathy (CN), osteomyelitis (OM), and CN complicated with superimposed OM in diabetic patients is crucial for the treatment choice. Given that current diagnostic methods lack specificity, advanced techniques, e.g., magnetic resonance imaging (MRI) and 99mTc-HMPAO-WBC Single Photon Emission Computed Tomography (SPECT/CT), are needed. This study addresses the challenges in distinguishing OM and CN.

Methods: We included diabetic patients with CN and soft tissue ulceration. MRI and 99mTc-HMPAO-WBC SPECT/CT were used for the diagnosis. The patients were classified into three probability levels for OM (i.e., Definite, Probable, and Unlikely) according to the Consensus Criteria for Diabetic Foot Osteomyelitis (CC-DFO).

Results: Eight patients met the eligibility criteria. MRI, supported by SPECT-CT and CC-DFO, showed consistency with the OM diagnosis in three cases. The key diagnostic features included the location of signal abnormalities and secondary features such as skin ulcers, sinus tracts, and abscesses. Notably, cases with inconclusive MRI were clarified by SPECT/CT, emphasizing its efficacy in challenging scenarios.

Conclusions: The primary objective of this study was to compare the results of MRI and 99mTc-HMPAO-WBC SPECT/CT with the CC-DFO score in the diabetic foot with CN and suspected OM. Advanced imaging offers a complementary approach to distinguish between CN and OM. This can help delineate the limits of the disease for presurgical planning. While MRI is valuable, 99mTc-HMPAO-WBC SPECT/CT provides additional clarity, especially in challenging cases or when metallic implants affect MRI accuracy.

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磁共振成像和 99Tc WBC-SPECT/CT 扫描在骨髓炎和夏科神经关节病鉴别诊断中的应用：病例系列。

背景：区分糖尿病患者的查尔科特神经性关节病（CN）、骨髓炎（OM）和CN并发叠加OM对治疗选择至关重要。鉴于目前的诊断方法缺乏特异性，因此需要先进的技术，如磁共振成像（MRI）和 99mTc-HMPAO-WBC 单光子发射计算机断层扫描（SPECT/CT）。本研究解决了区分 OM 和 CN 的难题：我们纳入了患有 CN 和软组织溃疡的糖尿病患者。磁共振成像和 99mTc-HMPAO-WBC SPECT/CT 用于诊断。根据糖尿病足骨髓炎共识标准（CC-DFO），将患者分为三个OM可能性等级（即肯定、可能和不可能）：结果：八名患者符合资格标准。在 SPECT-CT 和 CC-DFO 的支持下，核磁共振成像显示三例患者的 OM 诊断一致。主要诊断特征包括信号异常的位置和继发特征，如皮肤溃疡、窦道和脓肿。值得注意的是，核磁共振成像无定论的病例通过 SPECT/CT 得到了明确诊断，强调了 SPECT/CT 在具有挑战性的情况下的有效性：本研究的主要目的是比较 MRI 和 99mTc-HMPAO-WBC SPECT/CT 与 CC-DFO 评分在患有 CN 和疑似 OM 的糖尿病足中的结果。先进的成像技术为区分 CN 和 OM 提供了一种补充方法。这有助于确定疾病的范围，以便制定手术前计划。虽然核磁共振成像很有价值，但 99mTc-HMPAO-WBC SPECT/CT 还能提供额外的清晰度，尤其是在具有挑战性的病例或金属植入物影响核磁共振成像准确性的情况下。

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来源期刊

Tomography Medicine-Radiology, Nuclear Medicine and Imaging

CiteScore

2.70

自引率

10.50%

发文量

222

期刊介绍： TomographyTM publishes basic (technical and pre-clinical) and clinical scientific articles which involve the advancement of imaging technologies. Tomography encompasses studies that use single or multiple imaging modalities including for example CT, US, PET, SPECT, MR and hyperpolarization technologies, as well as optical modalities (i.e. bioluminescence, photoacoustic, endomicroscopy, fiber optic imaging and optical computed tomography) in basic sciences, engineering, preclinical and clinical medicine. Tomography also welcomes studies involving exploration and refinement of contrast mechanisms and image-derived metrics within and across modalities toward the development of novel imaging probes for image-based feedback and intervention. The use of imaging in biology and medicine provides unparalleled opportunities to noninvasively interrogate tissues to obtain real-time dynamic and quantitative information required for diagnosis and response to interventions and to follow evolving pathological conditions. As multi-modal studies and the complexities of imaging technologies themselves are ever increasing to provide advanced information to scientists and clinicians. Tomography provides a unique publication venue allowing investigators the opportunity to more precisely communicate integrated findings related to the diverse and heterogeneous features associated with underlying anatomical, physiological, functional, metabolic and molecular genetic activities of normal and diseased tissue. Thus Tomography publishes peer-reviewed articles which involve the broad use of imaging of any tissue and disease type including both preclinical and clinical investigations. In addition, hardware/software along with chemical and molecular probe advances are welcome as they are deemed to significantly contribute towards the long-term goal of improving the overall impact of imaging on scientific and clinical discovery.