Indexing severity of diabetic foot infection with 99mTc-WBC SPECT/CT hybrid imaging

William A. Erdman, Param Maewal, Ji Buethe, Jon Anderson, Rafia Bhore, Steve Klemow, Hans K. Ghayee, Orhan K. Oz, Chiarra Thompson

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

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 aimis 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 99mTc-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 - 99mTc-WBC SPECT/CT hybrid image-derived wound infection parameters incorporated into a standardized scoring system, CSI, has prognostic value in DFI.

Original languageEnglish (US)
Pages (from-to)1826-1831
Number of pages6
JournalDiabetes Care
Volume35
Issue number9
DOIs
StatePublished - Sep 2012

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Multimodal Imaging
Diabetic Foot
Single-Photon Emission-Computed Tomography
Leukocytes
Osteomyelitis
Wound Infection
Infection
Municipal Hospitals
Treatment Failure
Amputation
ROC Curve
Research Design
Odds Ratio
Tomography
Anti-Bacterial Agents
Therapeutics

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialized Nursing

Cite this

Erdman, W. A., Maewal, P., Buethe, J., Anderson, J., Bhore, R., Klemow, S., ... Thompson, C. (2012). Indexing severity of diabetic foot infection with 99mTc-WBC SPECT/CT hybrid imaging. Diabetes Care, 35(9), 1826-1831. https://doi.org/10.2337/dc11-2425

Indexing severity of diabetic foot infection with 99mTc-WBC SPECT/CT hybrid imaging. / Erdman, William A.; Maewal, Param; Buethe, Ji; Anderson, Jon; Bhore, Rafia; Klemow, Steve; Ghayee, Hans K.; Oz, Orhan K.; Thompson, Chiarra.

In: Diabetes Care, Vol. 35, No. 9, 09.2012, p. 1826-1831.

Research output: Contribution to journalArticle

Erdman, WA, Maewal, P, Buethe, J, Anderson, J, Bhore, R, Klemow, S, Ghayee, HK, Oz, OK & Thompson, C 2012, 'Indexing severity of diabetic foot infection with 99mTc-WBC SPECT/CT hybrid imaging', Diabetes Care, vol. 35, no. 9, pp. 1826-1831. https://doi.org/10.2337/dc11-2425
Erdman, William A. ; Maewal, Param ; Buethe, Ji ; Anderson, Jon ; Bhore, Rafia ; Klemow, Steve ; Ghayee, Hans K. ; Oz, Orhan K. ; Thompson, Chiarra. / Indexing severity of diabetic foot infection with 99mTc-WBC SPECT/CT hybrid imaging. In: Diabetes Care. 2012 ; Vol. 35, No. 9. pp. 1826-1831.
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AU - Bhore, Rafia

AU - Klemow, Steve

AU - Ghayee, Hans K.

AU - Oz, Orhan K.

AU - Thompson, Chiarra

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N2 - 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 aimis 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 99mTc-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 - 99mTc-WBC SPECT/CT hybrid image-derived wound infection parameters incorporated into a standardized scoring system, CSI, has prognostic value in DFI.

AB - 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 aimis 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 99mTc-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 - 99mTc-WBC SPECT/CT hybrid image-derived wound infection parameters incorporated into a standardized scoring system, CSI, has prognostic value in DFI.

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