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Dual-isotope SPECT/CT impact on hospitalized patients with suspected diabetic foot infection: saving limbs, lives, and resources

Heiba, Sherifa; Kolker, Dovb; Ong, Leonarda; Sharma, Shalinia; Travis, Arlenea; Teodorescu, Victoriac; Ellozy, Sharifc; Kostakoglu, Lalea; Savitch, Inaa; Machac, Josefa

doi: 10.1097/MNM.0b013e32836370a6
Original Articles

Background Foot ulcer with suspected infection is one of the most common reasons for hospitalization and a major factor contributing to morbidity and high healthcare-related expenses among diabetic patients. Many patients will require amputation; however, major amputation is associated with an alarmingly high 5-year mortality rate. In this study, we assess the diagnosis and management of suspected foot infection in diabetic patients using dual-isotope (DI) single-photon emission computed tomography/computed tomography (SPECT/CT) compared with conventional imaging.

Methods The diagnostic accuracy in and management of 227 patients who had undergone DI SPECT/CT was compared with that of 232 similar patients who had undergone conventional imaging including plain radiography, CT, planar bone scanning, planar indium-111 white blood cell scanning, and MRI. The duration of hospitalization was additionally compared between these two groups of patients after excluding patients with other active comorbidities.

Results Soft-tissue infection, osteomyelitis with or without soft-tissue infection, and other bony pathologies were more accurately and confidently identified with DI SPECT/CT than with conventional imaging. DI SPECT/CT use was associated with significantly fewer major amputations and more selective bony resection as well as with shorter duration of hospitalization when compared with conventional imaging.

Conclusion In this large population of diabetic patients with suspected foot infection DI SPECT/CT was more accurate in diagnosing and localizing infection compared with conventional imaging. In addition, DI SPECT/CT provided clear guidance and promoted many limb salvage procedures. Of equal importance to health economics, DI SPECT/CT use was associated with considerably reduced length of hospitalization compared with conventional imaging.

aDepartment of Radiology, Nuclear Medicine Division

bDepartment of Orthopedics

cDepartment of Surgery, Vascular Surgery Division, Mount Sinai School of Medicine, New York, New York, USA

Correspondence to Sherif Heiba, MD, Department of Radiology, Nuclear Medicine Division, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1141, New York, NY 10029-6574, USA Tel: +1 212 241 9373; fax: +1 212 831 2851; e-mail:

Received February 12, 2013

Accepted May 20, 2013

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins