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

Authors :
Sara Cecchini
Cristina Gatti
Daniela Fornarelli
Lorenzo Fantechi
Cinzia Romagnolo
Elena Tortato
Anna Rita Bonfigli
Roberta Galeazzi
Fabiola Olivieri
Giuseppe Bronte
Enrico Paci
Source :
Tomography, Vol 10, Iss 8, Pp 1312-1319 (2024)
Publication Year :
2024
Publisher :
MDPI AG, 2024.

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.

Details

Language :
English
ISSN :
2379139X and 23791381
Volume :
10
Issue :
8
Database :
Directory of Open Access Journals
Journal :
Tomography
Publication Type :
Academic Journal
Accession number :
edsdoj.777ccd3c6e7b46cfb866666e14df65bc
Document Type :
article
Full Text :
https://doi.org/10.3390/tomography10080098