Pioneering PET/CT research widens applications of imaging for diabetic foot

Pioneering research with combined positron emission tomography (PET) and computed tomography (CT) scans provides accurate detection and localization of foot infection in diabetic patients, according to an article in the March issue of the Journal of Nuclear Medicine. PET/CT scans could potentially offer a single-step, noninvasive technique for the diagnosis of infection, said Society of Nuclear Medicine member Zohar Keidar, M.D., Ph.D., the article’s lead author.

Keidar explained that foot infection is one of the most severe complications of diabetes. Diabetes can lead to decreased circulation in one’s extremities. This poor circulation–and the reduced ability to fight off minor infections–put diabetics at risk for development of chronic infection involving bone and soft tissues. “Early detection of infection is crucial and may prevent amputation,” said Keidar, explaining that antibiotic therapy can cure these infections if administered in time.

Keidar and his colleagues at Rambam Medical Center in Haifa, Israel, used PET/CT, the novel technology that combines two imaging modalities in one device, in their study of foot infection. By using labeled glucose (radiotracer 18F-FDG), Israeli physicians demonstrated the presence of infection with PET imaging. CT scans showed the localization of the infection site detected by PET as well as structural changes in bone and soft tissues. “This combined imaging approach in a single session using a single device leads to better localization of the infection process and facilitates the diagnosis,” noted the lead author of “The Diabetic Foot: Initial Experience With 18F-FDG PET/CT.” PET/CT technology, which is being used currently for cancer evaluation, may be applied potentially to the investigation of infection during evaluation of prolonged fever, suspected infected vascular graft or limb prosthesis, he added.

The group’s preliminary results have been “enthusiastically welcomed” by nuclear medicine professionals and referring physicians, especially orthopedic and vascular surgeons, said Keidar, who is with Rambam Medical Center’s department of nuclear medicine and Technion–Israel Institute of Technology’s school of medicine, both in Haifa, Israel. He believes that these findings will encourage additional investigations on the role of PET/CT in infection and inflammation in larger patient populations.

The authors of “The Diabetic Foot: Initial Experience With 18F-FDG PET/CT” are Zohar Keidar, M.D., Ph.D., Rambam Medical Center’s department of nuclear medicine and Technion–Israel Institute of Technology’s school of medicine, both in Haifa, Israel; Daniela Militianu, M.D., Rambam Medical Center’s department of diagnostic radiology, Haifa, Israel; Eyal Melamed, M.D., Rambam Medical Center’s department of orthopedics, Haifa, Israel; SNM member Rachel Bar-Shalom, M.D., Rambam Medical Center’s department of nuclear medicine, Haifa, Israel; and SNM member Ora Israel, M.D., Rambam Medical Center’s department of nuclear medicine and Technion–Israel Institute of Technology’s school of medicine, both in Haifa, Israel.