Unsuspected osteomyelitis in diabetic foot ulcers. Diagnosis and monitoring by leukocyte scanning with indium in 111 oxyquinoline

Journal Article · Wed Sep 04 04:00:00 EDT 1991 · JAMA, Journal of the American Medical Association; (United States)

DOI:https://doi.org/10.1001/jama.1991.03470090080036· OSTI ID:5228829

Newman, L G; Waller, J; Palestro, C J; Schwartz, M; Klein, M J; Hermann, G; Harrington, E; Harrington, M; Roman, S H; Stagnaro-Green, A ^[1]

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1. Mount Sinai Medical Center, New York, NY (USA)

The prevalence of osteomyelitis in diabetic foot ulcers is unknown. Early diagnosis of this infection is critical, as prompt antibiotic treatment decreases the rate of amputation. The authors therefore assessed the prevalence of osteomyelitis in 35 diabetic patients with 41 foot ulcers. They compared results of roentgenograms, leukocyte scans with indium In 111 oxyquinoline, and bone scans with the diagnostic criterion standards of bone histologic and culture findings. Leukocyte scans were repeated at 2- to 3-week intervals during antibiotic treatment. Consecutive samples were obtained from 54 diabetic patients. Thirty-five patients with 41 foot ulcers were included. As determined by bone biopsy and culture, osteomyelitis was found to underlie 28 (68%) of 41 diabetic foot ulcers. Only nine (32%) of the 28 cases were diagnosed clinically by the referring physician. Underscoring the clinically silent nature of osteomyelitis in these ulcers, 19 (68%) of 28 occurred in outpatients, 19 (68%) of 28 occurred in ulcers not exposing bone, and 18 (64%) of 28 had no evidence of inflammation on physical examination. All patients with ulcers that exposed bone had osteomyelitis. Of the imaging tests, the leukocyte scan had the highest sensitivity, 89%. In patients with osteomyelitis, the leukocyte scan image intensity decreased by 16 to 34 days of antibiotic treatment and normalized by 36 to 54 days. The majority of diabetic foot ulcers have an underlying osteomyelitis that is clinically unsuspected. Leukocyte scans are highly sensitive for diagnosing osteomyelitis in diabetic foot ulcers and may be useful for monitoring the efficacy of antibiotic treatment. The recommend that diabetic patients with foot ulcers that expose bone should be treated for osteomyelitis.

• OSTI ID: 5228829
• Journal Information: JAMA, Journal of the American Medical Association; (United States), Journal Name: JAMA, Journal of the American Medical Association; (United States) Vol. 266:9; ISSN 0098-7484; ISSN JAMAA
• Country of Publication: United States
• Language: English

Related Subjects

550601* -- Medicine-- Unsealed Radionuclides in Diagnostics
62 RADIOLOGY AND NUCLEAR MEDICINE
BETA DECAY RADIOISOTOPES
BIOLOGICAL MATERIALS
BLOOD
BLOOD CELLS
BODY
BODY AREAS
BODY FLUIDS
COUNTING TECHNIQUES
DAYS LIVING RADIOISOTOPES
DIABETES MELLITUS
DIAGNOSIS
DISEASES
ELECTRON CAPTURE RADIOISOTOPES
ENDOCRINE DISEASES
FEET
INDIUM 111
INDIUM ISOTOPES
INTERMEDIATE MASS NUCLEI
ISOMERIC TRANSITION ISOTOPES
ISOTOPES
LEGS
LEUKOCYTES
LIMBS
MATERIALS
METABOLIC DISEASES
MINUTES LIVING RADIOISOTOPES
NUCLEI
ODD-EVEN NUCLEI
ORGANS
OSTEOMYELITIS
PATHOLOGICAL CHANGES
RADIOISOTOPE SCANNING
RADIOISOTOPES
SENSITIVITY ANALYSIS
SKELETAL DISEASES
SKELETON
ULCERS