title: Diagnostic performance of Fluorine-18-Fluorodeoxyglucose positron emission tomography for the diagnosis of osteomyelitis related to diabetic foot: a systematic review and a meta-analysis.
abstract: OBJECTIVE
  To systematically review and meta-analyse published data about the diagnostic performance of Fluorine-18-Fluorodeoxyglucose ((18)F-FDG) positron emission tomography (PET) and PET/computed tomography (PET/CT) in osteomyelitis related to diabetic foot.
  
  
  METHODS
  A comprehensive literature search of studies on (18)F-FDG-PET and PET/CT in patients with diabetic foot was performed. Pooled sensitivity, specificity, positive and negative likelihood ratio (LR+ and LR-) and diagnostic odds ratio (DOR) and area under the summary ROC curve of (18)F-FDG-PET and PET/CT in patients with osteomyelitis related to diabetic foot were calculated.
  
  
  RESULTS
  Nine studies comprising 299 patients with diabetic foot were included in the qualitative analysis (systematic review) and discussed. The quantitative analysis (meta-analysis) of four selected studies provided the following results on a per patient-based analysis: sensitivity was 74% [95% confidence interval (95%CI): 60-85%], specificity 91% (95%CI: 85-96%), LR+ 5.56 (95%CI: 2.02-15.27), LR- 0.37 (95%CI: 0.10-1.35), and DOR 16.96 (95%CI: 2.06-139.66). The area under the summary ROC curve was 0.874.
  
  
  CONCLUSIONS
  In patients with suspected osteomyelitis related to diabetic foot (18)F-FDG-PET and PET/CT demonstrated a high specificity, being potentially useful tools if combined with other imaging methods such as MRI. Nevertheless, the literature focusing on the use of (18)F-FDG-PET and PET/CT in this setting remains still limited.
authors.affiliation: Department of Nuclear Medicine and PET/CT Center, Ente Ospedaliero Cantonale, Bellinzona, Switzerland. Electronic address: giorgiomednuc@libero.it.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Treglia
authors.forename: Ramin
authors.initials: R
authors.lastname: Sadeghi
authors.forename: Salvatore
authors.initials: S
authors.lastname: Annunziata
authors.forename: Seyed Rasoul
authors.initials: SR
authors.lastname: Zakavi
authors.forename: Carmelo
authors.initials: C
authors.lastname: Caldarella
authors.forename: Barbara
authors.initials: B
authors.lastname: Muoio
authors.forename: Francesco
authors.initials: F
authors.lastname: Bertagna
authors.forename: Luca
authors.initials: L
authors.lastname: Ceriani
authors.forename: Luca
authors.initials: L
authors.lastname: Giovanella
mesh_terms: D017719:Diabetic Foot / Q000000981:diagnostic imaging*; D019788:Fluorodeoxyglucose F18; D006801:Humans; D064847:Multimodal Imaging; D010019:Osteomyelitis / Q000000981:diagnostic imaging*; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: (18)F-FDG; Diabetic foot; Osteomyelitis; PET/CT; Positron emission tomography