title: Comparison Between Tc-99m WBC SPECT/CT and MRI for the Diagnosis of Biopsy-proven Diabetic Foot Osteomyelitis.
abstract: OBJECTIVE
  Magnetic resonance imaging (MRI) is the recommended diagnostic imaging technique for diabetic foot osteomyelitis (DFO), with a reported accuracy of 79%. The gold standard to diagnose osteomyelitis is bone biopsy, with a positive culture and/or histopathology findings consistent with osteomyelitis. The purposes of this study are to assess the accuracy of technetium-99m (Tc-99m) labeled white blood cell (WBC) single-photon emission computed tomography/computed tomography (SPECT/CT) hybrid imaging for diagnosing DFO confirmed by bone biopsy and to compare that to the diagnostic accuracy of an MRI.
  
  
  METHODS
  The authors performed a retrospective chart review of 166 patients who received a bone biopsy to confirm the diagnosis of a suspected DFO at a large municipal hospital between 2010 and 2013. Patients were selected on the basis of whether they received an MRI or a SPECT/CT. Patients whose scans were not within a clinically relevant time frame of the biopsy were excluded. Imaging results were correlated with probability of osteomyelitis determined by bone biopsy.
  
  
  RESULTS
  For inclusion criteria, 110 patients met the study's criteria: 52 SPECT/CT patients and 58 MRI patients. The sensitivity, specificity, positive predictive value, and negative predictive value of SPECT/CT were 89%, 35%, 74%, and 60%, respectively; the corresponding values for MRI were 87%, 37%, 74%, and 58%, respectively. There were no significant differences in accuracy of diagnosing DFO between imaging techniques.
  
  
  CONCLUSIONS
  This data suggests that the diagnostic accuracy of SPECT/CT imaging in DFOs is similar to an MRI.
authors: Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
authors: Javier
authors: J
authors: La Fontaine
authors: Department of Internal Medicine, Infectious Diseases, University of Texas Southwestern Medical Center, Dallas, TX.
authors: Kavita
authors: K
authors: Bhavan
authors: Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
authors: Kenrick
authors: K
authors: Lam
authors: Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
authors: Suzanne
authors: S
authors: Van Asten
authors: Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX.
authors: William
authors: W
authors: Erdman
authors: Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
authors: Lawrence A
authors: LA
authors: Lavery
authors: Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX.
authors: Orhan K
authors: OK
authors: Öz
mesh_terms: D001842:Bone and Bones / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D007962:Leukocytes / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D010019:Osteomyelitis / Q000000981:diagnostic imaging* / Q000473:pathology; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals / Q000627:therapeutic use*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013669:Technetium Tc 99m Medronate / Q000627:therapeutic use*; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D019275:Radiopharmaceuticals; D013669:Technetium Tc 99m Medronate