FDG-PET Imaging in Complicated Diabetic Foot

描述（由申请人提供）：1100万美国糖尿病患者中约有25%患有周围神经病变，糖尿病相关的足部并发症占下肢非创伤性截肢的大多数。在这个人群中，骨髓炎和足部深部感染是相对常见的并发症。这些并发症的早期诊断在这些患者的管理中至关重要，因为及时的抗生素治疗可以治愈感染，从而可以降低截肢率。然而，在这种情况下，建立骨髓炎的诊断是相当困难的，因为并发症，如外周血管疾病，蜂窝织炎，神经病变和骨关节病，这可能会掩盖骨髓炎的临床表现。许多截肢是由于缺乏一个单一的测试，是高度敏感，具体和成本效益的早期诊断骨髓炎。目前的诊断测试，包括常规放射照相术，实验室研究，核医学程序，和磁共振成像（MRI）遭受重大的缺点，如不够准确和成本。已显示[18F]氟脱氧葡萄糖（FDG）和正电子发射断层扫描（PET）以高灵敏度和准确性揭示炎症部位。在我们机构进行的试点研究中，我们已经能够证明FDG-PET成像在小患者人群中诊断骨科感染具有很高的准确性。拟议研究的主要目的是确定FDG-PET成像在糖尿病足患者中诊断骨髓炎或深部感染的有效性。我们还打算将FDG-PET成像直接与MRI进行比较，以确定FDG-PET成像是否上级这种常用技术。我们还将研究一种新的磁共振（MR）技术（由我们的研究者之一开发）在检测骨髓水肿和骨丢失作为这种并发症的结果的潜在效用。我们计划在四年内招募240名患者，用于申请中概述的目的。通过利用所提出的工作，我们将能够证明这种技术在糖尿病足患者的管理的敏感性，特异性和有效性。我们相信，这项有前途的技术在准确诊断这一严重且具有挑战性的临床问题方面具有巨大潜力，并可能对这些患者的结局产生重大影响。

DESCRIPTION (provided by applicant): Approximately 25 percent of the 11 million Americans with diabetes suffer from peripheral neuropathy and diabetic related foot complications account for the majority of nontraumatic amputations of the lower extremity. In this population, osteomyelitis and deep infection of the foot are relatively common complications. Early diagnosis of these complications is crucial in the management of these patients, because prompt antibiotic treatment cure infection and therefore can decrease the rate of amputation. However, establishing the diagnosis of osteomyelitis is quite difficult in this setting because of concurrent conditions, such as peripheral vascular disease, cellulitis, neuropathy and osteoarthropathy, which can obscure the clinical manifestations of osteomyelitis. Much of the amputations are due to the lack of a single test that is highly sensitive, specific and cost effective in the early diagnosis of osteomyelitis. Current diagnostic tests including routine radiography, laboratory studies, nuclear medicine procedures, and magnetic resonance imaging (MRI) suffer from significant shortcomings such as inadequate accuracy and cost. It has been shown that [18F] fluorine deoxyglucose (FDG) and Positron Emission Tomography (PET) reveal sites of inflammation with high sensitivity and accuracy. In the pilot study conducted at our institution, we have been able to demonstrate that FDG-PET imaging has high accuracy in the diagnosis of orthopedic infection in a small patient population. The main objective of the proposed research study is to determine the efficacy of FDG-PET imaging in the diagnosis of osteomyelitis or deep infection in patients with diabetic foot in a large patient population. We also intend to compare FDG-PET imaging directly to MRI to determine whether FDG-PET imaging is superior to this commonly used technique. We will also examine the potential utility of a novel magnetic resonance (MR) technique (developed by one of our investigators) in detecting marrow edema and bone loss as a result of such complications. We plan to enroll 240 patients over four years for the purposes outlined in the application. By utilization of the proposed work, we will be able to demonstrate the sensitivity, specificity, and effectiveness of this technique in the management of patients with diabetic foot. We believe this promising technology has great potential for the accurate diagnosis of this serious and challenging clinical problem, and may substantially influence the outcome in these patients.