Imaging Techniques for Diabetic Foot Osteomyelitis

Diabetic foot osteomyelitis represents a serious complication of diabetes, arising from the spread of infection to bone and warranting timely and accurate diagnosis to guide therapy and prevent amputation. Conventional radiography often serves as a first step but lacks sensitivity in early disease. Magnetic resonance imaging (MRI) provides excellent soft-tissue contrast and bone‐marrow detail, making it the reference standard for detecting marrow involvement and distinguishing osteomyelitis from neuropathic changes. Nuclear medicine approaches complement MRI by visualising inflammatory activity and cellular uptake. White blood cell (WBC) scintigraphy, single-photon emission computed tomography with computed tomography (SPECT/CT) and positron emission tomography with 18F-fluorodeoxyglucose (FDG PET/CT) each yield functional insight into leukocyte migration or glucose metabolism within infected bone. Quantitative parameters such as the maximum standardised uptake value (SUVmax) have emerged as objective markers of disease severity and predictors of outcome. Recent innovations include hybrid imaging techniques combining anatomical and molecular information, refined chemical shift sequences to differentiate infectious marrow oedema from neuropathic changes, and novel radiotracers targeting active bone remodelling. Together, these modalities form an integrated diagnostic toolkit that informs surgical margins, antimicrobial regimens and risk stratification for limb salvage.

Research from Nature Portfolio

New data demonstrate that quantitative 99mTc-labelled WBC SPECT/CT parameters can predict the risk of lower extremity amputation in patients with diabetic foot infection. In a cohort study involving over 80 patients, the number of SPECT/CT lesions and the SUVmax within infected regions emerged as independent predictors of major amputation. By applying logistic regression and receiver operating characteristic analysis, researchers developed a prognostic model combining clinical history and imaging metrics that achieved excellent discriminative performance. This work underscores the value of integrating quantitative functional imaging into multidisciplinary treatment planning, enabling personalised risk assessment and better informed surgical decision-making.

Imaging Techniques for Diabetic Foot Osteomyelitis publication trend

The graph below shows the total number of articles in imaging techniques for diabetic foot osteomyelitis across all publications each year (not limited to Nature Index journals).

Technical terms

Magnetic resonance imaging (MRI): A non-invasive modality using magnetic fields and radiofrequency pulses to generate detailed images of soft tissue and bone marrow.

Single-photon emission computed tomography/computed tomography (SPECT/CT): A hybrid imaging technique combining functional tracer uptake data with anatomical CT for precise localisation of inflammatory processes.

Positron emission tomography/computed tomography (PET/CT): A nuclear medicine method that detects positron-emitting radiotracers, such as 18F-FDG, to visualise metabolic activity in infected or inflamed tissue.

White blood cell (WBC) scintigraphy: A technique in which autologous leukocytes are labelled with a gamma-emitting tracer to track migration of inflammatory cells to sites of infection.

Maximum standardised uptake value (SUVmax): A quantitative PET or SPECT metric representing the highest concentration of radiotracer uptake within a region of interest, used to assess disease severity.

Chemical shift imaging (Dixon sequence): An MRI acquisition method that separates fat and water signals to characterise bone-marrow oedema and distinguish infectious from non-infectious changes.

References

1. Diagnostic imaging of the diabetic foot: an EANM evidence-based guidance. European Journal of Nuclear Medicine and Molecular Imaging (2024).
2. The usefulness of quantitative 99mTc-HMPAO WBC SPECT/CT for predicting lower extremity amputation in diabetic foot infection. Scientific Reports (2024).
3. Comparison of White Blood Cell Scintigraphy, FDG PET/CT and MRI in Suspected Diabetic Foot Infection: Results of a Large Retrospective Multicenter Study. Journal of Clinical Medicine (2020).
4. Diagnostic performance of quantitative Ga-SPECT/CT for patients with lower-limb osteomyelitis. European Journal of Hybrid Imaging (2022).
5. Novel Application of 18F-NaF PET/CT Imaging for Evaluation of Active Bone Remodeling in Diabetic Patients With Charcot Neuropathy: A Proof-of-Concept Report. Frontiers in Medicine (2022).
6. The utility of chemical shift imaging and related Dixon images in evaluation of bone marrow edema-like changes in diabetic foot. Egyptian Journal of Radiology and Nuclear Medicine (2023).