Potential role of FDG PET in the setting of diabetic neuro-osteoarthropathy: can it differentiate uncomplicated Charcot's neuroarthropathy from osteomyelitis and soft-tissue infection?
Potential role of FDG PET in the setting of diabetic neuro-osteoarthropathy: can it differentiate uncomplicated Charcot's neuroarthropathy from osteomyelitis and soft-tissue infection?
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DOI：
10.1097/mnm.0b013e328174447f
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发表时间：
2007-06-01
影响因子：
1.5
通讯作者：
Alavi, Abass
中科院分区：
文献类型：
--
作者：
Basu, Sandip;Chryssikos, Timothy;Alavi, Abass
背景本文是基于一个正在进行的前瞻性试验的结果，旨在探讨FDG PET在复杂的diabeticfoot.Aim的有用性，探讨FDG PET成像在急性神经性骨关节病（Charcot's foot）.Patients和Methods的设置的潜在效用。这些小组是：（A）17例临床诊断为Charcot神经关节病的患者（111例男性，6例女性;平均年龄：59.4 ± 8.6岁）;（13）21例无并发症糖尿病足患者（16名男性，5名女性;平均年龄：63 ± 10岁）;（C）20名下肢正常的非糖尿病患者（12名男性，8名女性;平均年龄54 - 19岁）;和V 5例确诊继发于复杂性糖尿病足的骨髓炎患者（3名男性，2名女性;平均年龄：61.2 +/- 13.9岁）。A组5例患者有足部溃疡，中度至高度怀疑叠加骨髓炎。除MRI外，每位受试者均接受下肢FDG PET成像，并将结果与基于组织病理学和临床随访的最终诊断结果进行比较。目视检查图像是否存在局灶性异常。对FDG摄取异常的部位进行感兴趣区的划分，计算最大标准摄取值探讨了两个重要的临床决策问题：（1）FDG PET是否显示Charcot神经关节病的明确摄取模式，如果是，是否可用于将其与其他复杂形式的糖尿病足如骨髓炎和蜂窝织炎区分开，这在临床上经常是一个诊断挑战;（2）FDG PET在检测Charcot足患者软组织感染中的准确性如何。这些问题进行了检查，利用FDG PET的结果沿着与MRI结果在同一patient.Results我们观察到一个低程度的弥漫性FDG摄取的夏科氏关节。这与正常关节有明显区别。夏科氏病变的SUVmax为0.7 ~ 2.4（平均1.3 ± 0.4），而正常对照组和无并发症糖尿病足的中足的SUVmax分别为0.2 ~ 0.7（平均0.42 ± 0.12）和0.2 ~ 0.8（平均0.5 ± 0.16）。唯一的患者与夏科的脚叠加骨髓炎有一个SUV，a。的6.5。糖尿病足并发症骨髓炎部位的SUVmax为2.9-6.2（平均值：4.38 ± 1.39）。单因素方差分析显示，四组间SUVmax差异有统计学意义（P < 0.01）。正常对照组与无并发症糖尿病足组的SUVmax经Student检验无统计学意义（P > 0.05）。在同时发生足部溃疡的情况下，FDG PET准确地排除了骨髓炎。FDG PET诊断夏科氏足的总体敏感性和准确性分别为100%和93.8%，MRI分别为76.9%和75%。FDGPET检查显示软组织内异常增强的病灶，提示炎症7例（43.75%），病理证实继发于感染。在这些情况下，只有两个功能的软组织感染的磁共振images.Conclusion的结果支持一个有价值的作用，FDG PET在设置Charcot的神经关节病的可靠区分骨髓炎一般和足部溃疡时存在。
Background This paper is based on the results from an ongoing prospective trial designed to investigate the usefulness of FDG PET in the complicated diabetic foot.Aim To investigate the potential utility of FDG PET imaging in the setting of acute neuropathic osteoarthropathy (Charcot's foot).Patients and methods A total of 63 patients, in four groups, were evaluated. The groups were: (A) 17 patients with a clinical diagnosis of Charcot's neuroarthropathy (111 men, six women; mean age: 59.4 +/- 8.6 years); (13) 21 patients with uncomplicated diabetic foot (16 men, five women; mean age: 63 10 years); (C) 20 non-diabetic patients with normal lower extremities (12 men, eight women; mean age 54 19 years); and V five patients with proven osteomyelitis secondary to complicated diabetic foot (three men, two women; mean age: 61.2 +/- 13.9 years). Five patients in group A had foot ulcer and intermediate to high degree of suspicion for superimposed osteomyelitis. Each subject underwent FDG PET imaging of the lower extremities in addition to MRI and the findings were compared with the final diagnostic outcome based on histopathology and clinical follow-up. The images were examined visually for focal abnormalities. Regions of interest were assigned to the sites of abnormal FDG uptake for calculating maximum standardized uptake value (SUVmax Two important clinical decision-making issues were explored: (1) whether FDG PET shows a definitive uptake pattern in Charcot's neuroarthropathy and if so whether that could be utilized to differentiate it from other complicated forms of diabetic foot like osteomyelitis and cellulitis, which is frequently a diagnostic challenge in this clinical setting; and (2) how accurate FDG PET is in detection soft tissue infection in patients with Charcot's foot. These issues were examined by utilizing FDG PET findings along with MRI results in the same patient.Results We observed a low degree of diffuse FDG uptake in the Charcot's joints. This was clearly distinguishable from the normal joints. The SUVmax), in the Charcot's lesions varied from 0.7 to 2.4 (mean, 1.3 +/- 0.4) while those of midfoot of the normal control subjects and the uncomplicated diabetic foot ranged from 0.2 to 0.7 (mean 0.42 +/- 0.12) and from 0.2 to 0.8 (mean 0.5 +/- 0.16), respectively. The only patient with Charcot's foot with superimposed osteomyelitis had an SUV,a. of 6.5. The SUVmax of the sites of osteomyelitis as a complication of diabetic foot was 2.9-6.2 (mean: 4.38 +/- 1.39). Unifactorial analysis of variance test yielded a statistical significance in the SUVmax between the four groups (P < 0.01). The SUVmax between the normal control groups and the uncomplicated diabetic foot was not statistically significant by the Student's Mest (P > 0.05). In the setting of concomitant foot ulcer FDG PET accurately ruled out osteomyelitis. Overall sensitivity and accuracy of FDG PET in the diagnosis of Charcot's foot was 100 and 93.8%, respectively; and for MRI were 76.9 and 75%, respectively. FDG PET showed foci of abnormally enhanced uptake in the soft tissue which was suggestive of inflammation in seven cases (43.75%) which were proven pathologically to be secondary to infection. In only two of these cases the features of soft tissue infection were noted on the magnetic resonance images.Conclusion The results support a valuable role of FDG PET in the setting of Charcot's neuroarthropathy by reliably differentiating it from osteomyelitis both in general and when foot ulcer is present.