title: F-18 FDG PET/CT scanning in Charcot disease: a brief report.
abstract: OBJECTIVE
  because of the increasing prevalence of diabetes, complications of diabetes will also become more prevalent. The pathophysiology of Charcot neuro-osteoarthropathy (Charcot disease) as a complication of diabetes is still enigmatic. As a consequence, the optimal diagnostic, follow-up, and therapeutic strategies are unclear. To obtain more insight into the relation between bony abnormalities and the (concurrent) inflammatory response in acute Charcot disease, thereby creating more insight into the pathophysiology of this disease, we performed F-18 FDG PET/CT scanning.
  
  
  METHODS
  We performed F-18 FDG PET/CT and Tc-99m bone scintigraphy in 10 patients with Charcot disease. Bony abnormalities on CT-scan and areas of increased uptake on F-18 FDG PET and Tc-99m bone scintigraphy were assessed independently. Subsequently, fused PET/CT images were evaluated for number and location of PET lesions.
  
  
  RESULTS
  nine patients had increased uptake of F-18 FDG, indicating inflammation, in 25 areas of soft tissue and/or bone without concurrent bony abnormalities on CT.
  
  
  CONCLUSIONS
  presented F-18 FDG PET/CT data may indicate an inflammatory origin of Charcot disease, with secondary bone resorption, possibly due to decreased inhibitory neurogenic inflammatory responses as a result of small fiber neuropathy. If these findings can be confirmed in future studies, F-18 FDG PET/CT scanning may be added to the diagnostic arsenal in Charcot disease, and anti-inflammatory drugs may be added to the therapeutic arsenal.
authors.affiliation: Division of Endocrinology, Department of Internal Medicine, Maastricht University Medical Centre, CAPHRI Research School, Maastricht, The Netherlands. k.pickwell@mumc.nl
authors.forename: Kristy M
authors.initials: KM
authors.lastname: Pickwell
authors.forename: Marinus J
authors.initials: MJ
authors.lastname: van Kroonenburgh
authors.forename: René E
authors.initials: RE
authors.lastname: Weijers
authors.forename: Pauline V
authors.initials: PV
authors.lastname: van Hirtum
authors.forename: Maya S
authors.initials: MS
authors.lastname: Huijberts
authors.forename: Nicolaas C
authors.initials: NC
authors.lastname: Schaper
mesh_terms: D000328:Adult; D000368:Aged; D001177:Arthropathy, Neurogenic / Q000000981:diagnostic imaging*; D005260:Female; D019788:Fluorodeoxyglucose F18; D005528:Foot / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography; D017256:Technetium Tc 99m Sestamibi; D014057:Tomography, X-Ray Computed
chemical_list: D019788:Fluorodeoxyglucose F18; D017256:Technetium Tc 99m Sestamibi