title: Mild-to-moderate hyperglycemia will not decrease the sensitivity of 18F-FDG PET imaging in the detection of pedal osteomyelitis in diabetic patients.
abstract: OBJECTIVE
  Pedal osteomyelitis is a worrisome complication of diabetic foot disease. Controlling serum glucose levels is difficult for many diabetic patients. High serum glucose levels could potentially affect the results of fluorine-18 fluorodeoxyglucose (18F-FDG) PET imaging in the detection of osteomyelitis. The aim of this investigation was to determine whether high serum glucose levels diminish the diagnostic accuracy of 18F-FDG PET imaging in detecting pedal osteomyelitis in diabetic patients.
  
  
  METHODS
  Forty-eight consecutive diabetic patients with a suspicion of pedal osteomyelitis were included in this investigation. At the time of 18F-FDG administration, 21 patients had serum glucose levels less than 150 mg/dl (group A), and 27 had serum glucose levels greater than 150 mg/dl (group B). Results of PET imaging were compared with final diagnostic outcome based on histopathology and/or 12 months' clinical follow-up.
  
  
  RESULTS
  Osteomyelitis was confirmed in 17 patients. 18F-FDG PET correctly detected osteomyelitis in 15 of 17 patients for a sensitivity of 88.3% (15/17). This technique successfully excluded osteomyelitis in 30 of 31 cases for a specificity of 96.8% (30/31) and an overall accuracy of 93.8% (45/48). The sensitivity of 18F-FDG PET imaging was 87.5% (7/8) in patients with serum glucose levels less than 150 mg/dl (group A) and 88.9% (8/9) in patients with serum glucose levels greater than 150 mg/dl (group B). These results do not significantly differ from the overall sensitivity of 88.3% (15/17).
  
  
  CONCLUSIONS
  Mildly to moderately elevated serum glucose levels do not adversely affect the accuracy of 18F-FDG PET imaging in the detection of pedal osteomyelitis in diabetic patients.
authors.affiliation: aDepartment of Radiology, Division of Nuclear Medicine, University of Pennsylvania Perelman School of Medicine, Hospital of the University of Pennsylvania bDepartment of Radiology, Division of Nuclear Medicine, University of Pennsylvania Perelman School of Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA cDepartment of Nuclear Medicine, PET/CT Centre, Radiology, Interventional Radiology NeuroRadiology, Medical Physics, Clinical Laboratory, Biomarkers Laboratory, Pathology, Microbiology, 'Santa Maria della Misericordia' Hospital, Rovigo, Italy.
authors.forename: Hua
authors.initials: H
authors.lastname: Yang
authors.forename: Hongming
authors.initials: H
authors.lastname: Zhuang
authors.forename: Domenico
authors.initials: D
authors.lastname: Rubello
authors.forename: Abass
authors.initials: A
authors.lastname: Alavi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017719:Diabetic Foot / Q000097:blood / Q000150:complications* / Q000000981:diagnostic imaging*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D006943:Hyperglycemia / Q000150:complications*; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000097:blood / Q000150:complications* / Q000000981:diagnostic imaging*; D049268:Positron-Emission Tomography; D012680:Sensitivity and Specificity
chemical_list: D019788:Fluorodeoxyglucose F18