scholarly journals Leukocyte Imaging of the Diabetic Foot

2018 ◽  
Vol 24 (12) ◽  
pp. 1270-1276 ◽  
Author(s):  
Chiara Lauri ◽  
Andor W.J.M. Glaudemans ◽  
Alberto Signore
Keyword(s):  
Computed Tomography ◽  
Blood Cell ◽  
White Blood Cell ◽  
Diabetic Foot ◽  
Photon Emission ◽  
White Blood Cells ◽  
Diagnostic Methods ◽  
Emission Computed Tomography ◽  
Diabetic Foot Infection ◽  
White Blood Cell Scintigraphy

Background: Diagnosing diabetic foot infection is often difficult, despite several available diagnostic methods. Amongst these, several imaging modalities exist to evaluate the diabetic foot in case of a suspected osteomyelitis. Nuclear Medicine, in particular, offers a variety of radiopharmaceuticals and techniques. Nowadays the gold standard radionuclide procedure, when an osteomyelitis is suspected, is represented by the use of radiolabelled leukocytes with either 99mTc-HMPAO or 111In-oxine. Methods: : In this review, we describe the correct acquisition and interpretation of white blood cell scintigraphy and we provide an overview of the existing literature data of the use of this technique in the infected diabetic foot. If images are correctly acquired, displayed and interpreted, this modality reaches very high diagnostic accuracy (>95%) in detecting osteomyelitis and it allows the differential diagnosis with a soft tissue infection or inflammation. Single-photon emission computed tomography/computed tomography (SPECT/CT) in addition to planar images is mandatory to determine the extent and exact location of the infective process in both fore foot and midhint foot. With the addition of bone marrow scintigraphy using radiolabelled nanocolloids, radiolabelled white blood cell scintigraphy is also able to differentiate between Charcot neuroarthropathy and osteomyelitis, which is a challenge in the evaluation of diabetic foot. Radiolabelled anti-granulocyte monoclonal antibodies and their fragments can also be used instead of white blood cells although there is a limited experience on their usefulness in diabetic foot infection.

The Infected Diabetic Foot: Re-evaluating the Infectious Diseases Society of America Diabetic Foot Infection Classification

2019 ◽  
Vol 70 (8) ◽  
pp. 1573-1579 ◽  
Author(s):  
Lawrence A Lavery ◽  
Easton C Ryan ◽  
Junho Ahn ◽  
Peter A Crisologo ◽  
Orhan K Oz ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Infectious Diseases ◽  
Diabetic Foot ◽  
Single Photon ◽  
Photon Emission ◽  
Severe Infection ◽  
Emission Computed Tomography ◽  
Bone Culture ◽  
Diabetic Foot Infection ◽  
Severe Infections

Abstract Background We provide evidence to revise the Infectious Diseases Society of America (IDSA) diabetic foot infection classification by adding a separate tier for osteomyelitis and evaluating if moderate and severe infection criteria improve the classification’s ability to direct therapy and determine outcomes. Methods We retrospectively evaluated 294 patients with moderate and severe infections. Osteomyelitis was confirmed by bone culture or histopathology. Soft tissue infection (STI) was based on negative bone culture, magnetic resonance imaging, or single-photon emission computed tomography. We stratified STI and osteomyelitis using IDSA criteria for moderate and severe infections and compared outcomes and complications. Results Osteomyelitis patients had greater antibiotic duration (32.5 ± 46.8 vs 63.8 ± 55.1 days; P < .01), surgery frequency (55.5% vs 99.4%; P < .01), number of surgeries (2.1 ± 1.3 vs 3.3 ± 2.3; P < .01), amputations (26.3% vs 83.4%; P < .01), reinfection (38.0% vs 56.7%; P < .01), and length of stay (14.5 ± 14.9 vs 22.6 ± 19.0 days; P < .01). There were no differences in moderate and severe STI outcomes except for infection readmissions (46.2% vs 25.0%; P = .02), and acute kidney injury (31.2% vs 50.0%; P = .03). There were no differences in moderate and severe osteomyelitis except the number of surgeries (2.8 ± 2.1 vs 4.1 ± 2.5; P < .01) and length of stay (18.6 ± 17.5 vs 28.2 ± 17.7; P < .01). Conclusions The IDSA classification better reflects outcomes if risk categories are stratified by STI or osteomyelitis and moderate and severe infections are not categorized separately.

scholarly journals Comparison of White Blood Cell Scintigraphy, FDG PET/CT and MRI in Suspected Diabetic Foot Infection: Results of a Large Retrospective Multicenter Study

2020 ◽  
Vol 9 (6) ◽  
pp. 1645 ◽  
Author(s):  
Chiara Lauri ◽  
Andor W.J.M. Glaudemans ◽  
Giuseppe Campagna ◽  
Zohar Keidar ◽  
Marina Muchnik Kurash ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Blood Cell ◽  
White Blood Cell ◽  
Diabetic Foot ◽  
Fdg Pet ◽  
Imaging Modality ◽  
Diabetic Foot Infections ◽  
Pet Ct ◽  
White Blood Cell Scintigraphy ◽  
Fdg Pet Ct

Diabetic foot infections (DFIs) represent one of the most frequent and disabling morbidities of longstanding diabetes; therefore, early diagnosis is mandatory. The aim of this multicenter retrospective study was to compare the diagnostic accuracy of white blood cell scintigraphy (WBC), 18F-fluorodeoxyglucose positron emission tomography/computed tomography ((18F) FDG PET/CT), and Magnetic Resonance Imaging (MRI) in patients with suspected DFI. Images and clinical data from 251 patients enrolled by five centers were collected in order to calculate the sensitivity, specificity, and accuracy of WBC, FDG, and MRI in diagnosing osteomyelitis (OM), soft-tissue infection (STI), and Charcot osteoarthropathy. In OM, WBC acquired following the European Society of Nuclear Medicine (EANM) guidelines was more specific and accurate than MRI (91.9% vs. 70.7%, p < 0.0001 and 86.2% vs. 67.1%, p = 0.003, respectively). In STI, both FDG and WBC achieved a significantly higher specificity than MRI (97.9% and 95.7% vs. 83.6%, p = 0.04 and p = 0.018, respectively). In Charcot, both MRI and WBC demonstrated a significantly higher specificity and accuracy than FDG (88.2% and 89.3% vs. 62.5%, p = 0.0009; 80.3% and 87.9% vs. 62.1%, p < 0.02, respectively). Moreover, in Charcot, WBC was more specific than MRI (89.3% vs. 88.2% p < 0.0001). Given the limitations of a retrospective study, WBC using EANM guidelines was shown to be the most reliable imaging modality to differentiate between OM, STI, and Charcot in patients with suspected DFI.

scholarly journals Detection of Osteomyelitis in the Diabetic Foot by Imaging Techniques: A Systematic Review and Meta-analysis Comparing MRI, White Blood Cell Scintigraphy, and FDG-PET

Diabetes Care ◽  
2017 ◽  
Vol 40 (8) ◽  
pp. 1111-1120 ◽  
Author(s):  
Chiara Lauri ◽  
Menno Tamminga ◽  
Andor W.J.M. Glaudemans ◽  
Luis Eduardo Juárez Orozco ◽  
Paola A. Erba ◽  
...  
Keyword(s):  
Systematic Review ◽  
Blood Cell ◽  
White Blood Cell ◽  
Diabetic Foot ◽  
Fdg Pet ◽  
Imaging Techniques ◽  
Meta Analysis ◽  
White Blood Cell Scintigraphy

scholarly journals Role of vascular disorders in lung injury in patients with rheumatoid arthritis

2016 ◽  
Vol 15 (3) ◽  
pp. 15-23 ◽  
Author(s):  
I. I. Nesterovich ◽  
K. V. Nochevnaya ◽  
Y. D. Rabik ◽  
A. A. Speranskaya ◽  
V. P. Zolotnitskaya ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Computed Tomography ◽  
Lung Injury ◽  
Pulmonary Function Tests ◽  
Photon Emission ◽  
Diagnostic Methods ◽  
Control Group ◽  
Emission Computed Tomography ◽  
Vascular Disorders

Introduction. The incidence of respiratory system involvement in patients with rheumatoid arthritis (RA) has currently increased; thereby new diagnostic methods have been developed actively. Meanwhile role of vascular disorders in pathogenesis of lung injury is almost unknown and single-photon emission computed tomography (SPECT) isn't used as method of lung assessment in RA. The detector of endothelial glycocalyx damage syndecan-1 is little known but potentially perspective serum marker of lung injury in RA. Objective. The purpose of the study was to investigate the role of vascular disorders in lung injury in patients with RA. Materials and methods. 61 patients with RA without comorbid lung diseases were enrolled in the study. Control group consisted of 26 healthy persons. Patients underwent survey and physical examination, high-resolution computed tomography (HRCT) and SPECT of the lungs and pulmonary function tests (PFTs). Also serum levels of rheumatoid factor (RF), anti-cyclic citrullinated peptide antibodies (ACCP) and syndecan-1 were measured. Results. All patients developed microcirculation impairment on SPECT. Vascular disorders were according to changes of lung structure detected by HRCT (r = 0.434; p = 0.044). Areas of hypoperfusion matched with ground glass opacities, lung fibrosis, branching linear structures and airway obstruction on HRCT-SPECT fusion scans. Syndecan-1 level was higher in patients with RA compared with healthy controls (р = 0.019). Conclusion. Vascular disorders are important in pathogenesis of lung injury in RA, and SPECT has high sensitivity in lung assessment. Perfusion impairment in lungs correlates with syndecan-1 level, thus syndecan-1 could be used as marker of lung injury in RA thereafter.

Value of white blood cell count with differential in the acute diabetic foot infection

1996 ◽  
Vol 86 (5) ◽  
pp. 224-227 ◽  
Author(s):  
DG Armstrong ◽  
TA Perales ◽  
RT Murff ◽  
GW Edelson ◽  
JG Welchon
Keyword(s):  
Blood Cell ◽  
Cell Count ◽  
White Blood Cell Count ◽  
White Blood Cell ◽  
Diabetic Foot ◽  
Polymorphonuclear Leukocyte ◽  
White Cell ◽  
Blood Cell Count ◽  
Diabetic Foot Infection ◽  
Cell Counts

The authors reviewed the admission leukocyte indices of 338 consecutive admissions (203 males, 135 females, mean age of 60.2 +/- 12.9 years) with a primary diagnosis of diabetic foot infection in a multicenter retrospective study. The mean white blood cell count on admission for all subjects studied was calculated at 11.9 +/- 5.4 x 103 cells/mm3. Of all white blood cell counts secured for patients admitted with a diabetic foot infection, 56% (189 out of 338) were within normal limits. The average automated polymorphonuclear leukocyte percentage was calculated at 71.4 +/- 11.1% (normal range 40% to 80%). Normal polymorphonuclear leukocyte values were present in 83.7% of subjects. The authors stress that the diagnosis of a diabetic pedal infection is made primarily on the basis of clinical signs and symptoms, and that a normal white cell count and white cell differential should not deter the physician from taking appropriate action to mitigate the propagation of a potentially limb-threatening pedal infection.

scholarly journals Tc99m-HMPAO white blood cell scintigraphy: added value of SPECT/CT for infection diagnosis in cardiothoracic surgery

2012 ◽  
Vol 2 (1) ◽  
pp. 5
Author(s):  
Napoleone Prandini ◽  
Stefano Panareo ◽  
Rosario Cultrera ◽  
Chiara Peterle ◽  
Valentina De Cristofaro ◽  
...  
Keyword(s):  
Blood Cell ◽  
White Blood Cell ◽  
Single Photon ◽  
Photon Emission ◽  
Anterior Mediastinum ◽  
Cardiothoracic Surgery ◽  
Added Value ◽  
Emission Computed Tomography ◽  
Planar Imaging ◽  
Mediastinal Infection

We report a case of a woman who came to our attention because of fever and a sternal fistula draining purulent fluid. Four years before, she had undergone cardiothoracic surgery to place a patch because of a myocardial rupture. Under suspicion of a deep mediastinal infection, a Tc99m-HMPAO white blood cell (WBC) scintigraphy was performed. The use of planar imaging and single photon emission computed tomography (SPECT/CT) imaging allowed the identification of a sternal infection, which involved the anterior mediastinum up to pericardium and diaphgram. SPECT/CT led to a precise diagnosis of a thoracic infection, providing the location and extent of the disease. This turned out useful to improve therapeutic strategies.

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