title: 18-F flourodeoxy glucose positron emission tomography-computed tomography imaging: A viable alternative to three phase bone scan in evaluating diabetic foot complications?
abstract: BACKGROUND
  This paper is based on the initial findings from a prospective ongoing study to evaluate the efficacy of flourodeoxy glucose positron emission tomography-computed tomography (FDG-PET CT) in diabetic foot evaluation.
  
  
  OBJECTIVE
  The aim was to compare the diagnostic accuracies of three phase bone scan (TPBS) and FDG PET-CT (FDG-PET) in diabetic foot evaluation.
  
  
  METHODS
  Seventy-nine patients with complicated diabetic foot (osteomyelitis/cellulitis, Charcot's neuropathy) were prospectively investigated. TPBS (15 mci methylene di phosphonate [MDP] intravenous [IV]), followed by FDG-PET (5 mci IV) within 5 days were performed in all patients. Based on referral indication, patients grouped into Group I, n = 36, (?osteomyelitis/cellulitis) and Group II, n = 43 (?Charcot's neuropathy). Interpretation was based on intensity, extent, pattern of MDP and FDG uptake (standardized uptake value) along with CT correlation. Findings were compared with final diagnostic outcome based on bone/soft tissue culture in Group I and clinical, radiological or scintigraphic followup in Group II.
  
  
  RESULTS
  Group I: For diagnosing osteomyelitis, TP: TN: FP: FN were 14:5:2:2 by FDG PET and 13:02:05:03 by TPBS respectively. Sensitivity, specificity, positive predictive value and negative predictive value (NPV) of FDG-PET were 87.5%, 71%, 87.5% and 71% and 81.25%, 28.5%, 72% and 40% for TPBS, respectively. Group II: charcot's: cellulitis: Normal were 22:14:7 by FDG PET and 32:5:6 by TPBS, respectively.
  
  
  CONCLUSIONS
  Flourodeoxy glucose PET-CT has a higher specificity and NPV than TPBS in diagnosing pedal osteomyelitis. TPBS, being highly sensitive is more useful than FDG-PET in detecting Charcot's neuropathy.
authors.affiliation: Department of Nuclear Medicine and PET-CT, Amrita Institute of Medical Sciences, Kochi, Kerala, India.
authors.forename: G S
authors.initials: GS
authors.lastname: Shagos
authors.affiliation: Department of Nuclear Medicine and PET-CT, Amrita Institute of Medical Sciences, Kochi, Kerala, India.
authors.forename: Palaniswamy
authors.initials: P
authors.lastname: Shanmugasundaram
authors.affiliation: Department of Podiatry, Nuclear Medicine and PET-CT, Amrita Institute of Medical Sciences, Kochi, Kerala, India.
authors.forename: Ajith Kumar
authors.initials: AK
authors.lastname: Varma
authors.affiliation: Department of Nuclear Medicine and PET-CT, Amrita Institute of Medical Sciences, Kochi, Kerala, India.
authors.forename: Subramanyam
authors.initials: S
authors.lastname: Padma
authors.affiliation: Department of Nuclear Medicine and PET-CT, Amrita Institute of Medical Sciences, Kochi, Kerala, India.
authors.forename: Manjit
authors.initials: M
authors.lastname: Sarma
keywords: Charcot's neuropathy; diabetic foot; flourodeoxy glucose-positron emission tomography; osteomyelitis; scintigraphy; three phase bone scan
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