Indexing Severity of Diabetic Foot Infection With 99mTc-WBC SPECT/CT Hybrid Imaging

被引:32
作者
Erdman, William A. [1 ]
Buethe, Ji [2 ]
Bhore, Rafia [3 ]
Ghayee, Hans K. [2 ]
Thompson, Chiarra [1 ]
Maewal, Param [1 ]
Anderson, Jon [1 ]
Klemow, Steve [2 ]
Oz, Orhan K. [1 ]
机构
[1] Univ Texas SW Med Ctr Dallas, Dept Radiol, Dallas, TX 75390 USA
[2] Univ Texas SW Med Ctr Dallas, Dept Internal Med, Dallas, TX 75390 USA
[3] Univ Texas SW Med Ctr Dallas, Dept Clin Sci Biostat, Dallas, TX 75390 USA
关键词
LABELED LEUKOCYTE; NUCLEAR-MEDICINE; OSTEOMYELITIS; DIAGNOSIS; BONE; SCINTIGRAPHY; ACCURACY; MRI;
D O I
10.2337/dc11-2425
中图分类号
R5 [内科学];
学科分类号
100201 [内科学];
摘要
OBJECTIVE-Management of diabetic foot infection (DFI) has been hampered by limited means of accurately classifying disease severity. New hybrid nuclear/computed tomography (CT) imaging techniques elucidate a combination of wound infection parameters not previously evaluated as outcome prognosticators. Our aim is to determine if a novel standardized hybrid image based scoring system, Composite Severity Index (CSI), has prognostic value in DFI. RESEARCH DESIGN AND METHODS-Masked retrospective Tc-99m-white blood cell (WBC) single photon emission CT (SPECT)/CT image interpretation and independent chart review of 77 patients (101 feet) suspected of DFI-associated osteomyelitis at a large municipal hospital between January 2007 and July 2009. CSI scores were correlated with probability of favorable outcome (no subsequent amputation/readmission after therapeutic intervention) during median 342-day follow-up. RESULTS-CSI ranged from 0-13. Receiver operating characteristic accuracy for predicting favorable outcome was 0.79 (optimal cutoff CSI, <= 2; odds ratio of therapeutic failure for CSI > 2, 15.1 [95% CI 4.4-51.5]). CSI of 0 had a 92% chance of favorable outcome, which fell progressively to 25% as indices rose to >= 7. Image-based osteomyelitis versus no osteomyelitis assessment was less accurate than CSI at predicting outcome (P = 0.016). In patients with intermediate severity (CSI 3-6), treatment failure decreased from 68 to 36% when antibiotic duration was extended to >= 42 days (P = 0.026). CONCLUSIONS-Tc-99m-WBC SPECT/CT hybrid image derived wound infection parameters incorporated into a standardized scoring system, CSI, has prognostic value in DFI.
引用
收藏
页码:1826 / 1831
页数:6
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