#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Capabilities of scintigraphy in patients with diabetic foot syndrome


Authors: Otto Lang 1,2,3;  Ivana Kuníková 1
Authors‘ workplace: Klinika nukleární medicíny, 3. lékařská fakulta UK a FN Královské Vinohrady, Praha 10 1;  Oddělení nukleární medicíny, Oblastní nemocnice Příbram, a. s. 2;  Oddělení nukleární medicíny, PMCD s. r. o., Praha 6, ČR 3
Published in: NuklMed 2019;8:52-59
Category: Review Article

Overview

Introduction: Diabetic foot syndrome is a serious and a complex disease which can come to an amputation. Early diagnosis of potential complications is essential for an effective therapy; scintigraphic procedures can contribute signficantly thanks to their high sensitivity and minimal invasiveness.

Methods: Properties of radiopharmacueticals, namely their tissue and celular distribution, are employed in scintigraphy. Their distribution can be detected by dynamic or static, planar or tomographic (SPECT, PET) including hybrid imaging (SPECT/CT, PET/CT). Bone scan gives information about the blood flow to the foot, about the capillary permeability and about the metabolic activity of osteoblasts and osteoclasts. Labeled white blood cells can be used to detect an infection and an inflammation (positive chemotaxis is utilized) as well as labeled glucose (increased energy demand). Lymphoscintigraphy can be used to detect a lymphedema.

Results: Bone scintigraphy has generaly high sensitivity but low specificity. The capability to semiquatitavely assess the metabolic rate of the bone tissue makes it possible to follow the course of the disease and the effect of the therapy by repetitive examination. Labeled leukocytes have a high specificity for an inflammation, hybrid imaging can help to differentiate cellulitis from osteomyelitis. Lymphoscintigraphy measures a velocity of a subcutaneously injected radiocolloid transport, it can discover also subclinical disorder. The detection of an increased glucose consuption is a non-specific marker, it is used for an inflammation and an atherosclerosis.

Conclusion: Scintigraphic procedures have a great diagnostic potential in patients with a diabetic foot syndrome. Bone and labeled leukocytes scintigraphy are the most routinely used procedures. The main advantage of scintigraphy is its low invasiveness, no contrast media and low radiation. They can be, therefore, safely used also in patients with a nephropathy and an allergy. The close cooperation with diabetologists is neccessary for the right interpretation.

Keywords:

scintigraphy – diabetic foot syndrome – bone – leukocytes – FDG – lymfphoscintigraphy


Sources
  1. Bakker K, Apelqvist J, Lipsky B et al. [International Working Group on the Diabetic Foot (IWGDF)]. The 2015 IWGDF guidance documents on prevention and management of foot problems in diabetes: development of an evidence-based global consensus. Diabetes Metab Res Rev 2016; 32(S1): S2-S6.

  2. International Diabetes Federation. IDF Diabetes Atlas (8th edn) [online]. 2017. [cit. 2019-07-22]. Dostupné na: https://diabetesatlas.org/across-the-globe.html

  3. Boulton AJ, Vileikyte L, Ragnarson-Tennvall G, et al. The global burden of diabetic foot disease. Lancet 2005;366:1719-1724

  4. Vibha SP, Kulkarni MM, Ballala ABK, et al. Community based study to assess the prevalence of diabetic foot syndrome and associated risk factors among people with diabetes mellitus. BMC Endocrine Disorders 2018;18:43

  5. Volmer-Thole M, Lobmann R. Neuropathy and Diabetic Foot Syndrome. Int J Mol Sci 2016;17:917; doi:10.3390/ijms17060917

  6. Jirkovská A. Syndrom diabetické nohy z pohledu internisty – podiatra. Vnitř Lék 2016; 62(S4): S42-S47

  7. Prompers L, Huijberts M, Schaper N, et al. Resource utilisation and costs associated with the treatment of diabetic foot ulcers. Prospective data from the Eurodiale study. Diabetologia 2008;51:1826-1834

  8. Lavery LA, Armstrong DG, Wunderlich RP, et al. Risk factors for foot infections in individuals with diabetes. Diabetes Care 2006;29:1288-1293

  9. Richard JL, Lavigne JP, Sotto A. Diabetes and foot infection: more than double trouble. Diabetes Metab Res Rev 2012;28(S1):46-53

  10. Moutschen MP, Scheen AJ, Lefebvre PJ. Impaired immune responses in diabetes mellitus: analysis of the factors and mechanisms involved. Relevance to the increased susceptibility of diabetic patients to specific infections. Diabetes Metab 1992;18:187-201

  11. Edmonds ME, Robert VC, Watkins PJ. Blood flow in the diabetic neuropathic foot. Diabetologia 1982;22:9-15

  12. Vinik AI, Maser RE, Mitchell BD, et al. Diabetic autonomic neuropathy. Diabetes Care 2003;26:1553-1579

  13. Hernandez-Cardoso GG, Rojas-Landeros SC, Alfaro-Gomez M, et al. Terahertz imaging for early screening of diabetic foot syndrome: A proof of concept. Sci Rep. 2017;7:42124. doi: 10.1038/srep42124.

  14. Peters EJ, Lavery LA, Armstrong DG. Diabetic lower extremity infection. Influence of physical, psychological, and social factors. J Diabetes Complications 2005;19:107-112

  15. Flynn MD, Tooke JE. Aetiology of diabetic foot ulceration: a role for the microcirculation? Diabet Med 1992;8:320-322

  16. Lee BY, Guerra VJ, Civelek B. Compartment syndrome in the diabetic foot. Adv Wound Care 1995;3:36-46

  17. Sotto A, Lina G, Richard J-L, et al. Virulence potential of Staphylococcus aureus strains isolated from diabetic foot ulcers. A new paradigm. Diabetes Care 2008;31:2318-2324

  18. James JA, Swogger E, Wolcott R, et al. Biofilms in chronic wounds. Wound Rep Reg 2008; 16: 37–44

  19. Apelqvist J. Diagnostics and treatment of the diabetic foot. Endocrine 2012;41:384-397

  20. Lipsky BA, Peters EJG, Senneville E, et al. Expert opinion on the management of infections in the diabetic foot. Diabetes Metab Res Rev 2012;28(S1):163-178

  21. Boulton AJ. The diabetic foot: Grand overview, epidemiology and pathogenesis. Diabet Metab Res Rev 2008;24(S1):S3–S6

  22. Lobmann R. Diabetic foot syndrome. Der Internist 2011;52:539–548

  23. Gilbey SG. Neuropathy and foot problems in diabetes. Clin Med 2004;4:318–323

  24. Peltier A, Goutman SA, Callaghan BC. Painful diabetic neuropathy. BMJ 2014;348:g1799

  25. Gibbons GW, Shaw PM. Diabetic Vascular Disease: Characteristics of Vascular Disease Unique to the Diabetic Patient. Semin Vasc Surg 2012;25:89-92

  26. Beckman JA, Creager MA, Libby P. Diabetes and atherosclerosis: epidemiology, pathophysiology, and management. J Am Med Assoc 2002;287:2570–2581

  27. Jörneskog G. Why critical limb ischemia criteria are not applicable to diabetic foot and what the consequences are. Scand J Surg 2012;101:114-118

  28. Glaudemans AWJM, Kwee TC, Slart RHJA. The Diabetic Foot. Curr Pharm Des. 2018;24:1241-1242

  29. Salmanoglu E, Kim S, Thakur ML. Currently Available Radiopharmaceuticals for Imaging Infection and the Holy Grail. Semin Nucl Med 2018;48:86-99

  30. Palestro CJ. Radionuclide Imaging of Musculoskeletal Infection: A Review. J Nucl Med 2016;57:1406-1412

  31. Ankrah AO, Klein HC, Elsinga PH. New imaging tracers for the infected diabetic foot (nuclear and optical imaging). Curr Pharm Des 2018;24:1287-1303

  32. Lauri C, Glaudemans AWJM, Signore A. Leukocyte imaging of the diabetic foot. Curr Pharm Des 2018;24:1270-1276

  33. Censullo A, Vijayan T. Using Nuclear Medicine Imaging Wisely in Diagnosing Infectious Diseases. Open Forum Infect Dis 2017;4:ofx011. doi: 10.1093/ofid/ofx011

  34. Lang O, Vašutová P, Trešlová L, et al. Perfuzní změny u neuropatické osteoartropatie – pilotní studie. Diabetologie, metabolismus, endokrinologie, výživa 2003;6(S1):39

  35. Lang O, Kuníková I. Třífázová scintigrafie značenými leukocyty u pacientů se syndromem diabetické nohy. Diabetologie, metabolismus, endokrinologie, výživa 2014;17(S1):48

  36. Lang O, Kuníková I, Píchová R, et al. Nová zobrazovací metoda SPECT/CT v diferenciální diagnóze osteomyelitidy u pacientů se syndromem diabetické nohy – první zkušenosti. Diabetologie, metabolismus, endokrinologie, výživa 2010;13(S1):22

  37. Lang O, Kuníková I, Píchová R, et al. Značené leukocyty zobrazené metodou SPECT/CT v diagnóze osteomyelitidy u pacientů se syndromem diabetické nohy – klinické zkušenosti. Diabetologie, metabolismus, endokrinologie, výživa 2011;14(S1):37

  38. Rastogi A, Bhattacharya A, Prakash M, et al. Utility of PET/CT with fluorine-18-fluorodeoxyglucose-labeled autologous leukocytes for diagnosing diabetic foot osteomyelitis in patients with Charcot‘s neuroarthropathy. Nucl Med Commun 2016;37:1253-1259

  39. Familiari D, Glaudemans AWJM, Vitale V, et al. Can Sequential 18F-FDG PET/CT Replace WBC Imaging in the Diabetic Foot? J Nucl Med 2011;52:1012–1019

  40. Belohlavek O, Jaruskova M. [18F]FDG-PET scan in patients with fasting hyperglycemia. Q J Nucl Med Mol Imaging 2016;60:404-412

  41. Leone A, Cassar-Pullicino VN, Semprini A, et al. Neuropathic osteoarthropathy with and without superimposed osteomyelitis in patients with a diabetic foot. Skeletal Radiol 2016;45:735-754

  42. Ramanujam CL, Zgonis T. The Diabetic Charcot Foot from 1936 to 2016. Eighty Years Later and Still Growing. Clin Podiatr Med Surg. 2017;34:1-8

  43. Fosbøl M, Reving S, Petersen EH, et al. Three-phase bone scintigraphy for diagnosis of Charcot neuropathic osteoarthropathy in the diabetic foot - does quantitative data improve diagnostic value? Clin Physiol Funct Imaging 2017;37:30-36

  44. Bem R, Jirkovska A, Dubsky M, et al. Role of Quantitative Bone Scanning in the Assessment of Bone Turnover in Patients With Charcot Foot. Diabetes Care 2010;33:348–349

  45. Wolfram RM, Budinsky AC, Sinzinger H. Assessment of peripheral arterial vascular disease with radionuclide techniques. Semin Nucl Med 2001;31:129-142

  46. Sayman HB, Urgancioglu I. Muscle Perfusion with Technetium-MIBI in Lower Extremity Peripheral Arterial Diseases. J NucIMed 1991;32:1700-1703

  47. Tellier P, Aquilanti S, Lecouffe P, et al. Comparison between exercise whole body thallium imaging and ankle-brachial index in the detection of peripheral arterial disease. Int Angiol 2000;19:212-219

  48. Kuníková I, Lang O, Syslová H, et al. Vliv diabetu na perfuzi a funkci myokardu u pacientů se suspektní nebo známou ICHS. [CD] Česká kardiologická společnost, Cor Vasa 2011;53(S1)

  49. McKenney-Drake ML, Moghbel MC, Paydary K, et al. 18F-NaF and 18F-FDG as molecular probes in the evaluation of atherosclerosis. Eur J Nucl Med Mol Imaging 2018;45:2190-2200

  50. Belcaro G, Laurora G, Cesarone MR, et al. Microcirculation in high perfusion microangiopathy. J Cardiovasc Surg (Torino) 1995;36:393-398

  51. Lin CT, Ou KW, Chang SC. Diabetic Foot Ulcers Combination with Lower Limb Lymphedema Treated by Staged Charles Procedure: Case Report and Literature Review. Pak J Med Sci 2013;29:1062-1064

  52. Kubinyi J, Knotková V, Hrbáč J, et al. Lymfoscintigrafie, provedení vyšetření a jeho interpretace. NuklMed 2018;7(S2):S1-S4

  53. Lang O, Prýmková V, Křížová H, et al. Lymfoscintigrafie dolních končetin u pacientů se syndromem diabetické nohy. Diabetologie, metabolismus, endokrinologie, výživa 2015;18(S1):48

Labels
Nuclear medicine Radiodiagnostics Radiotherapy
Topics Journals
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#