Open AccessDiagnosing osteomyelitis in the diabetic foot: a pilot study to examine the sensitivity and specificity of Tc 99m white blood cell‐labelled single photon emission computed tomography/computed tomography
Author(s) -
Przybylski Mallory M,
Holloway Samantha,
Vyce Steven D,
Obando Antonio
Publication year - 2016
Publication title -
international wound journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.867
H-Index - 63
eISSN - 1742-481X
pISSN - 1742-4801
DOI - 10.1111/iwj.12316
Subject(s) - medicine , diabetic foot , white blood cell , nuclear medicine , single photon emission computed tomography , radiology , osteomyelitis , confidence interval , spect imaging , radiography , retrospective cohort study , tomography , predictive value of tests , diabetes mellitus , surgery , endocrinology
Diabetic foot ulceration poses a significant threat of osteomyelitis (OM) and subsequent amputation. The diagnosis of OM via imaging studies is difficult as radiographic findings do not present immediately and advanced imaging studies may be contraindicated or unavailable. A novel diagnostic tool has been developed which synthesises technetium‐99 white blood cell‐labelled single‐photon emission computed tomography and computed tomography (Tc 99m WBC labelled‐ SPECT / CT ) imaging, effectively enhancing anatomic detail. The aim of this pilot study was to determine the validity and reliability of this novel imaging technique in patients with diabetic foot ulcers in a Veterans Affairs healthcare facility. A retrospective review was performed on consecutive patients who met the inclusion criteria ( n = 14) and underwent Tc 99m WBC‐labelled SPECT / CT for suspected OM. Histopathologic analysis of bone specimen (when available) and International Working Group on the Diabetic Foot consensus criteria were used as a reference standard. The sensitivity and specificity of Tc 99m WBC‐labelled SPECT / CT were 87·50% [confidence interval ( CI ): 64·58–110·42%] and 71·43% ( CI : 37·96–104·90%), respectively. Negative predictive value ( NPV ) and positive predictive value ( PPV ) were 83·33% ( CI : 53·51–113·15%) and 77·78% ( CI : 50·62–104·94%), respectively, with a likelihood ratio ( LR ) of 3·063 and an accuracy of 80%. These findings suggest Tc 99m WBC‐labelled SPECT / CT can be useful in imaging OM in patients with diabetic foot ulcers.