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J Nucl Med. 2008; 49 (Supplement 1):134P
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General Clinical Specialties: Infectious Disease/Hematology

Infectious Disease/Hematology

Can dual isotope SPECT/CT scan be a gold imaging standard for diabetic foot (DF) evaluation?

Sherif Heiba1, Dov Kolker2, Bhara Mocherla1, Balasubramanya Rangaswamy1, Lale Kostakoglu1 and Josef Machac1

1 Nuclear Medicine; 2 Orthopedics, Mt. Sinai School of Medicine, New York, New York

532

Objectives: We recently introduced a new comprehensive dual isotope (Tc-99m HDP/In-111 WBC) SPECT/CT (DI) protocol for DF evaluation. This protocol is not only practical & conserving of patient (pt) & camera time, but also helps precise registration of all images in a single acquisition. This study explores DI clinical utility in routine DF evaluation.

Methods: 3-phase blood flow & pool images were obtained followed by WBC reinjection & next day dual energy bone (BS) & WBC (WBCS) SPECT/CT acquisition. Additional Tc-99m sulfur colloid bone marrow/In-111 SPECT/CT (step 2 DI) was obtained on the following day in 16 pt with suspected mid/hindfoot osteomyelitis (OM) & WBC uptake confined only to bone. BS, WBCS, DI & step 2 DI were separately reviewed by 2 observers for diagnosis (Dx) & Dx confidence (uncertain, probable, certain) based on each scan. Final Dx was determined as OM, soft tissue infection (STI), OM/STI or other pathology by surgical/pathological &/or up to 17 months clinical follow-up.

Results: 85 pt (age 58 ± 14 years, 55 men) were evaluated. There was higher accuracy of final Dx prediction by DI than WBCS or BS alone, assessed by Lambda (0.88, 0.57, 0.1, respectively) & uncertainty coefficient error reduction (80%, 52%, 5%, respectively). Of 247 lesions identified, Dx confidence was higher (p < 0.001) in DI than WBCS (100 Vs 60/119) or BS (168 Vs 11/186) alone. All 16 pt with probable Dx by DI were confirmed by step 2 DI, achieving perfect prediction of final Dx.

Conclusions: DI is a highly accurate imaging protocol that considerably improves detection & discrimination of STI & OM while providing precise anatomic localization of DF infection. When needed, step 2 DI can further yield a comprehensive DF imaging for definitive Dx.





This Article
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Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Google Scholar
Right arrow Articles by Heiba, S.
Right arrow Articles by Machac, J.
PubMed
Right arrow Articles by Heiba, S.
Right arrow Articles by Machac, J.