Introduction and Objective: The objective of this study was to compare the performance of Tc-99m WBC SPECT/CT and MRI in subjects with suspected diabetic foot osteomyelitis (DFO) using bone biopsy as a reference standard.Methods: In total, 47 subjects with suspected DFO underwent MRI and Tc-99m WBC SPECT/CT imaging prior to bone biopsy. Subjects with soft tissue infection or DFO received a 6-8 week course of antibiotics. Post-therapy MRI, SPECT/CT, and bone biopsy were repeated in 20 subjects. Imaging studies and histopathology were blindly interpreted as either DFO positive or negative. Biopsies were considered positive if either bone culture or histopathology indicated bone infection. Imaging results were assessed against the reference biopsy to determine the sensitivity and specificity of each in both the initial diagnosis of DFO and monitoring response to antibiotic therapy.Results: Sensitivity, specificity, positive and negative predictive values on initial DFO diagnosis were 85%, 79%, 90% and 69% for SPECT/CT and 73%, 43%, 85% and 40% for MRI, respectively. The kappa coefficient of agreement between the two imaging modalities was only 0.47. Post-antibiotic imaging revealed identical sensitivity, specificity, positive and negative predictive values for SPECT/CT and MRI, with 75%, 75%, 40% and 92%, respectively.Conclusion: SPECT/CT demonstrated better sensitivity and specificity than MRI at initial diagnosis. However, MRI and SPECT/CT performed statistically equally in evaluation of DFO following antibiotic therapy. Our results indicate that compared to MRI, SPECT/CT is a viable, if not superior, method for primary non-invasive assessment of DFO.
O.K. Oz: None. A. Sherwood: None. P.A. Crisologo: None. A.L. Killeen: Advisory Panel; GMS Holding, Caleres, Inc. K.L. Rubitschung: None. H. Hwang: None. A. Chhabra: Consultant; Icon medical, treace med concepts. Advisory Panel; Ibl, inc. Research Support; Qure-ai, ibl, inc. Speaker’s Bureau; Telemed clinics. R.W. Haley: None. L.A. Lavery: Consultant; Limflow, enerenesis Medical, Clyra Medical technologies, Blue Sky, Tissue Health Plus. Stock/Shareholder; Xilas Medical. Consultant; Altrazeal.
American Diabetes Association (I-17-ICTS-056)
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