Leukocyte Scanning With 111In Is Superior to Magnetic Resonance Imaging in Diagnosis of Clinically Unsuspected Osteomyelitis in Diabetic Foot Ulcers
- Lisa G Newman, MD,
- John Waller, MD,
- Christopher J Palestro, MD,
- George Hermann, MD,
- Michael J Klein, MD,
- Myron Schwartz, MD,
- Elizabeth Harrington, MD,
- Martin Harrington, MD,
- Sheila H Roman, MD and
- Alex Stagnaro-Green, MD
- Department of Medicine, Division of Endocrinology and Metabolism; the Department of Surgery, Division of Orthopedic Surgery and Division of Vascular Surgery; the Department of Pathology; the Department of Nuclear Medicine; and the Department of Radiology, Mount Sinai Medical Center New York, New York
- Address correspondence and reprint requests to Lisa G. Newman, MD, Division of General Medicine, Mount Sinai Medical Center, I Gustave Levy Place, Box 1087, New York, NY 10029.
Abstract
OBJECTIVE To compare the accuracies of MRI and leukocyte scanning in diagnosing clinically unsuspected osteomyelitis in diabetic foot ulcers.
RESEARCH DESIGN AND METHODS A prospective study of 16 diabetic foot ulcers in 12 patients, including both ambulatory and hospitalized patients, was performed at a university medical center. Pedal images were obtained by leukocyte scanning with [111In]oxyquinoline and MRI. Definitive diagnosis of osteomyelitis then was determined by bone biopsy for culture and histology.
RESULTS Biopsy-proven osteomyelitis was present in 7 (44%) of the 16 foot ulcers. The diagnosis was suspected clinically in 0%. Leukocyte scanning was 100% sensitive, whereas MRI was only 29% sensitive in diagnosing osteomyelitis in diabetic foot ulcers. Specificities were 67 and 78%, respectively. The positive and negative predictive values (70 and 100%, respectively) for the leukocyte scan also were > those of MRI (50 and 58%, respectively).
CONCLUSIONS Leukocyte scanning is superior to MRI in detecting clinically unsuspected osteomyelitis in diabetic foot ulcers.
- Received January 29, 1992.
- Revision received July 2, 1992.
- Accepted July 2, 1992.
- Copyright © 1992 by the American Diabetes Association
