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

Chiara Lauri, Menno Tamminga, Andor W.J.M. Glaudemans, Luis Eduardo Juárez Orozco, Paola A. Erba, Paul C. Jutte, Benjamin A. Lipsky, Maarten J. IJzerman, Alberto Signore, Riemer H.J.A. Slart

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27 Citations (Scopus)

Abstract

OBJECTIVE: Diagnosing bone infection in the diabetic foot is challenging and often requires several diagnostic procedures, including advanced imaging. We compared the diagnostic performances of MRI, radiolabeled white blood cell (WBC) scintigraphy (either with 99mTc-hexamethylpropyleneamineoxime [HMPAO] or 111In-oxine), and [18F]fluorodeoxyglucose positron emission tomography (18F-FDG-PET)/ computed tomography.

RESEARCH DESIGN AND METHODS: We searchedMedline andEmbase as of August 2016 for studies of diagnostic tests on patients known or suspected to have diabetes and a foot infection. We performed a systematic review using criteria recommended by the Cochrane Review of a database that included prospective and retrospective diagnostic studies performed on patients with diabetes in whom there was a clinical suspicion of osteomyelitis of the foot. The preferred reference standard was bone biopsy and subsequent pathological (or microbiological) examination.

RESULTS: Our review found 6,649 articles; 3,894 in Medline and 2,755 in Embase. A total of 27 full articles and 2 posters was selected for inclusion in the analysis. The performance characteristics for the 18F-FDG-PET were: sensitivity, 89%; specificity, 92%; diagnostic odds ratio (DOR), 95; positive likelihood ratio (LR), 11; and negative LR, 0.11. For WBC scan with 111In-oxine, the values were: sensitivity, 92%; specificity, 75%; DOR, 34; positive LR, 3.6; and negative LR, 0.1. For WBC scan with 99mTc-HMPAO, the values were: sensitivity, 91%; specificity, 92%; DOR, 118; positive LR, 12; and negative LR, 0.1. Finally, forMRI, the valueswere: sensitivity, 93%; specificity, 75%; DOR, 37; positive LR, 3.66, and negative LR, 0.10.

CONCLUSIONS: The various modalities have similar sensitivity, but 18F-FDG-PET and 99mTc-HMPAO-labeled WBC scintigraphy offer the highest specificity. Larger prospective studies with a direct comparison among the different imaging techniques are required.

Original languageEnglish
Pages (from-to)1111-1120
Number of pages10
JournalDiabetes care
Volume40
Issue number8
DOIs
Publication statusPublished - 1 Aug 2017

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Diabetic Foot
Osteomyelitis
Radionuclide Imaging
Meta-Analysis
Fluorodeoxyglucose F18
Leukocytes
Odds Ratio
Positron-Emission Tomography
Foot
Bone and Bones
Posters
Infection
Routine Diagnostic Tests
Retrospective Studies
Databases
Prospective Studies
Biopsy
indium oxine

Cite this

Lauri, Chiara ; Tamminga, Menno ; Glaudemans, Andor W.J.M. ; Juárez Orozco, Luis Eduardo ; Erba, Paola A. ; Jutte, Paul C. ; Lipsky, Benjamin A. ; IJzerman, Maarten J. ; Signore, Alberto ; Slart, Riemer H.J.A. / 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. In: Diabetes care. 2017 ; Vol. 40, No. 8. pp. 1111-1120.
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title = "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",
abstract = "OBJECTIVE: Diagnosing bone infection in the diabetic foot is challenging and often requires several diagnostic procedures, including advanced imaging. We compared the diagnostic performances of MRI, radiolabeled white blood cell (WBC) scintigraphy (either with 99mTc-hexamethylpropyleneamineoxime [HMPAO] or 111In-oxine), and [18F]fluorodeoxyglucose positron emission tomography (18F-FDG-PET)/ computed tomography.RESEARCH DESIGN AND METHODS: We searchedMedline andEmbase as of August 2016 for studies of diagnostic tests on patients known or suspected to have diabetes and a foot infection. We performed a systematic review using criteria recommended by the Cochrane Review of a database that included prospective and retrospective diagnostic studies performed on patients with diabetes in whom there was a clinical suspicion of osteomyelitis of the foot. The preferred reference standard was bone biopsy and subsequent pathological (or microbiological) examination.RESULTS: Our review found 6,649 articles; 3,894 in Medline and 2,755 in Embase. A total of 27 full articles and 2 posters was selected for inclusion in the analysis. The performance characteristics for the 18F-FDG-PET were: sensitivity, 89{\%}; specificity, 92{\%}; diagnostic odds ratio (DOR), 95; positive likelihood ratio (LR), 11; and negative LR, 0.11. For WBC scan with 111In-oxine, the values were: sensitivity, 92{\%}; specificity, 75{\%}; DOR, 34; positive LR, 3.6; and negative LR, 0.1. For WBC scan with 99mTc-HMPAO, the values were: sensitivity, 91{\%}; specificity, 92{\%}; DOR, 118; positive LR, 12; and negative LR, 0.1. Finally, forMRI, the valueswere: sensitivity, 93{\%}; specificity, 75{\%}; DOR, 37; positive LR, 3.66, and negative LR, 0.10. CONCLUSIONS: The various modalities have similar sensitivity, but 18F-FDG-PET and 99mTc-HMPAO-labeled WBC scintigraphy offer the highest specificity. Larger prospective studies with a direct comparison among the different imaging techniques are required.",
author = "Chiara Lauri and Menno Tamminga and Glaudemans, {Andor W.J.M.} and {Ju{\'a}rez Orozco}, {Luis Eduardo} and Erba, {Paola A.} and Jutte, {Paul C.} and Lipsky, {Benjamin A.} and IJzerman, {Maarten J.} and Alberto Signore and Slart, {Riemer H.J.A.}",
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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. / Lauri, Chiara; Tamminga, Menno; Glaudemans, Andor W.J.M.; Juárez Orozco, Luis Eduardo; Erba, Paola A.; Jutte, Paul C.; Lipsky, Benjamin A.; IJzerman, Maarten J.; Signore, Alberto; Slart, Riemer H.J.A.

In: Diabetes care, Vol. 40, No. 8, 01.08.2017, p. 1111-1120.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Detection of osteomyelitis in the diabetic foot by imaging techniques

T2 - A systematic review and meta-analysis comparing mri, white blood cell scintigraphy, and FDG-PET

AU - Lauri, Chiara

AU - Tamminga, Menno

AU - Glaudemans, Andor W.J.M.

AU - Juárez Orozco, Luis Eduardo

AU - Erba, Paola A.

AU - Jutte, Paul C.

AU - Lipsky, Benjamin A.

AU - IJzerman, Maarten J.

AU - Signore, Alberto

AU - Slart, Riemer H.J.A.

PY - 2017/8/1

Y1 - 2017/8/1

N2 - OBJECTIVE: Diagnosing bone infection in the diabetic foot is challenging and often requires several diagnostic procedures, including advanced imaging. We compared the diagnostic performances of MRI, radiolabeled white blood cell (WBC) scintigraphy (either with 99mTc-hexamethylpropyleneamineoxime [HMPAO] or 111In-oxine), and [18F]fluorodeoxyglucose positron emission tomography (18F-FDG-PET)/ computed tomography.RESEARCH DESIGN AND METHODS: We searchedMedline andEmbase as of August 2016 for studies of diagnostic tests on patients known or suspected to have diabetes and a foot infection. We performed a systematic review using criteria recommended by the Cochrane Review of a database that included prospective and retrospective diagnostic studies performed on patients with diabetes in whom there was a clinical suspicion of osteomyelitis of the foot. The preferred reference standard was bone biopsy and subsequent pathological (or microbiological) examination.RESULTS: Our review found 6,649 articles; 3,894 in Medline and 2,755 in Embase. A total of 27 full articles and 2 posters was selected for inclusion in the analysis. The performance characteristics for the 18F-FDG-PET were: sensitivity, 89%; specificity, 92%; diagnostic odds ratio (DOR), 95; positive likelihood ratio (LR), 11; and negative LR, 0.11. For WBC scan with 111In-oxine, the values were: sensitivity, 92%; specificity, 75%; DOR, 34; positive LR, 3.6; and negative LR, 0.1. For WBC scan with 99mTc-HMPAO, the values were: sensitivity, 91%; specificity, 92%; DOR, 118; positive LR, 12; and negative LR, 0.1. Finally, forMRI, the valueswere: sensitivity, 93%; specificity, 75%; DOR, 37; positive LR, 3.66, and negative LR, 0.10. CONCLUSIONS: The various modalities have similar sensitivity, but 18F-FDG-PET and 99mTc-HMPAO-labeled WBC scintigraphy offer the highest specificity. Larger prospective studies with a direct comparison among the different imaging techniques are required.

AB - OBJECTIVE: Diagnosing bone infection in the diabetic foot is challenging and often requires several diagnostic procedures, including advanced imaging. We compared the diagnostic performances of MRI, radiolabeled white blood cell (WBC) scintigraphy (either with 99mTc-hexamethylpropyleneamineoxime [HMPAO] or 111In-oxine), and [18F]fluorodeoxyglucose positron emission tomography (18F-FDG-PET)/ computed tomography.RESEARCH DESIGN AND METHODS: We searchedMedline andEmbase as of August 2016 for studies of diagnostic tests on patients known or suspected to have diabetes and a foot infection. We performed a systematic review using criteria recommended by the Cochrane Review of a database that included prospective and retrospective diagnostic studies performed on patients with diabetes in whom there was a clinical suspicion of osteomyelitis of the foot. The preferred reference standard was bone biopsy and subsequent pathological (or microbiological) examination.RESULTS: Our review found 6,649 articles; 3,894 in Medline and 2,755 in Embase. A total of 27 full articles and 2 posters was selected for inclusion in the analysis. The performance characteristics for the 18F-FDG-PET were: sensitivity, 89%; specificity, 92%; diagnostic odds ratio (DOR), 95; positive likelihood ratio (LR), 11; and negative LR, 0.11. For WBC scan with 111In-oxine, the values were: sensitivity, 92%; specificity, 75%; DOR, 34; positive LR, 3.6; and negative LR, 0.1. For WBC scan with 99mTc-HMPAO, the values were: sensitivity, 91%; specificity, 92%; DOR, 118; positive LR, 12; and negative LR, 0.1. Finally, forMRI, the valueswere: sensitivity, 93%; specificity, 75%; DOR, 37; positive LR, 3.66, and negative LR, 0.10. CONCLUSIONS: The various modalities have similar sensitivity, but 18F-FDG-PET and 99mTc-HMPAO-labeled WBC scintigraphy offer the highest specificity. Larger prospective studies with a direct comparison among the different imaging techniques are required.

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DO - 10.2337/dc17-0532

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JO - Diabetes care

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