18F-FDG PET and PET/CT for the diagnosis of diabetic foot osteomyelitis

Early detection of the grade of diabetic foot infections helps in planning and treating the infections and also helps in assessing the prognosis and risk of limb loss. 

X-ray of foot, CT scan or MRI scan are helpful to detect the infections in the depths of the wound and bone involvement. But we would like to know the infection much earlier more accurately. PET scans may of some help in detecting the septic complications in the foot, but we don't know if PET CT is any better than the available methods. Recently as study was done and found that PET is no better than the available methods. The accuracy of 18F-FDG-PET and PET/CT for the diagnosis of diabetic foot osteomyelitis is, at the moment, far from encouraging. However, results should still be perhaps described as only preliminary. Indeed, additional investigation is needed, and future works should include more patients and be more precise in the reference method for the confirmation of osteomyelitis. More caution is also required in patient selection, to avoid those with excessive hyper- or hypoglycaemia. Indeed, such glucose fluctuations may, in theory, affect 18F-FDG tissue uptake, although this remains to be quantified. Further work towards standardisation of technological details and options of interpretation is urgently awaited, as well. In Greece, these modalities are only available on a very restricted basis, emphasising the need for further experience. Moreover, their use should be reasonable and affordable, in harmony with the financial restraints due to the current economic crisis. There is, certainly, still a long way to go, but improved early diagnosis of diabetic foot infections is a goal worth pursuing.