99mTc-white blood cell SPECT/CT to assess diabetic foot osteomyelitis remission: contribution of semi-quantitative scoring system. Issue 7 (July 2021)

• Record Type: Journal Article
• Authors: Vouillarmet, Julien; Tordo, Jeremie; Moret, Myriam; Michon, Paul; Morelec, Isabelle
• Is Part Of: Nuclear medicine communications. Volume 42:Issue 7(2021)
• Publication Date: 2021-07
• Subjects: diabetic foot -- nuclear imaging -- osteomyelitis -- single-photon emission computed tomography/computed tomography; Nuclear medicine -- Periodicals; 616.07575
• DOI: 10.1097/MNM.0000000000001390
• Languages: English
• ISSNs: 0143-3636

Abstract

Abstract : Aims: We previously reported that 99m Tc-White blood cell (WBC) single-photon emission computed tomography (SPECT/CT) could be a useful tool to assess diabetic foot osteomyelitis (DFO) remission and guide the duration of antibiotic treatment. The aim of the present study was to evaluate the performance and reproducibility of two analysis methods to diagnose DFO remission using 99m Tc-WBC-SPECT/CT. Methods: 99m Tc-WBC-SPECT/CT performed for patients with DFO at the end of antibiotic treatment were retrospectively read by two nuclear physicians (one senior and one junior). Assessment by conventional visual analysis and by the use of a semi-quantitative scoring system, the composite score index (CSI), was performed. The performance and reproducibility of methods were compared between the two nuclear physicians. Successful treatment of DFO was defined by the absence of DFO relapse at the same site within 1 year. Results: A total of 68 patients with 74 DFO were included. Three were excluded from the analysis due to the low quality of SPECT/CT; among the 71 DFO analyzed, 11 (15.5%) had a relapse during follow-up. Performances of 99m Tc-WBC-SPECT/CT to predict DFO remission with conventional visual assessment were significantly lower for junior than for senior nuclear physician with moderate inter-rater agreement (Kappa: 0.417). Performances with the use of CSI were similar between the two readers with good inter-rater agreement (Kappa: 0.756). Conclusion: The study found that conventional visual assessment of 99m Tc-WBC -SPECT/CT to assess DFO remission requires experience, and supported that CSI could be useful for junior nuclear physician to discriminate residual infections and inflammatory post-treatment uptake.