Prospective comparison of white blood cell (WBC) single photon emission computed tomography (SPECT)/computed tomography (CT) and conventional MRI for diagnosing osteomyelitis and monitoring treatment response in diabetic foot infections
Authors' conclusion
WBC SPECT/CT exhibits greater sensitivity and specificity than MRI at initial diagnosis. However, after treatment, WBC SPECT/CT and MRI perform equivalently in determining therapeutic response. Our results indicate WBC SPECT/CT is a viable, if not superior, method for primary non-invasive assessment of suspected DFO. To our knowledge, this is the first study to use paired bone biopsy to validate imaging in diabetic foot infections both before and after antibiotic intervention.
Study context
- Population
- Patients with foot wounds suspicious for diabetic foot osteomyelitis (DFO)20 re-imaged post-treatment
- Participants
- 47 patients
- Comparison
- WBC SPECT/CT vs conventional MRI for DFO, against bone biopsy
- Outcome
- Diagnostic performance (sensitivity, specificity, PPV, NPV) for initial DFO diagnosis vs bone biopsy (positive culture or histopathology)
Methodological detailsprospective, blinded interpretation, bone biopsy reference standard
- Prospective
- Blinded interpretation
- Bone biopsy reference standard
Performance
As reported in the abstract
| Test or model | Sensitivity | Specificity | PPV | NPV |
|---|---|---|---|---|
| WBC SPECT/CT | 85% | 79% | 90% | 69% |
| MRI | 73% | 43% | 75% | 40% |
Sensitivity
Specificity
PPV
NPV
Further findings
Residual infection after antibiotic therapy · after standard antibiotic course
Sensitivity
Specificity
PPV
NPV
Residual infection after antibiotic therapy · after standard antibiotic course
- Identical performance of WBC SPECT/CT and MRI after treatment
Original publication
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