Figure 1

(a) Abnormal leukocyte accumulation was observed in the right 1st to 5th toes, with the radioactive lesions extending to the bone, indicating osteomyelitis (left panel, MIP image; right panel, axial SPECT/CT). Two spherical VOIs were drawn on DFIs and the highest SUVmax was 4.2 (higher than the cutoff of 1.1) Despite intensive treatment, the infection progressed, leading to the patient undergoing right below knee amputation 43 days after SPECT/CT. (b) Mild focal abnormal leukocyte accumulation was detected in the right 3rd and 4th toes. The lesions were in contact with the bone, which raised a suspicion of osteomyelitis (left panel, MIP image; right panel, axial SPECT/CT). A circular VOI was drawn on DFIs and the SUVmax was 1.0 (lower than the cutoff of 1.1). After 10 weeks of antibiotic treatment, the infection was successfully resolved, and the foot was preserved.