Imaging osteomyelitis and the diabetic foot.

BACKGROUND: The clinical diagnosis of osteomyelitis and the diabetic foot is in most of the patients not possible without imaging the bone. The clinical problem is to diagnose infection as early, as reliable and as cheap as possible to prevent the possible longstanding and life-threatening complications.

METHODS: For imaging a lot of different radiological and nuclear medicine methods are available. This article focuses on the possible results of conventional plain radiography and tomography, computed tomography and magnetic resonance imaging as radiological methods and on bone scan, autologous white blood cell scintigraphy with 111In-oxin or 99mTc-HMPAO, antigranulocyte antibodies, 99mTc-/111In-human immunoglobulin, 67Ga-citrate and 99mTc-nanocolloids.

RESULTS: Different methods offer different answers. Radiological methods give detailed pathological answers, nuclear medicine methods answer questions of specificity such as leukocytic infiltration.

CONCLUSIONS: If osteomyelitis is suspected, plain radiography should be the first, three phase bone scintigraphy the second and infection specific radiopharmaceuticals the third step of examination. Only in negative images with high clinical suspicion CT or MRI should be the final imaging procedure. In the diabetic foot imaging cascade should also start with plain radiography, followed by three phase bone scintigraphy or MRI. If clinically neuropathy is present specific nuclear medicine imaging should be performed.