Imaging osteomyelitis and the diabetic foot

Background. The clinical diagnosis of osteomyelitis and the diabetic foot i s in most of the patients not possible without imaging the bone. The clinic al problem is to diagnose infection as early, as reliable and as cheap as p ossible to prevent the possible longstanding and life-threatening complicat ions, Methods. For imaging a lot of different radiological and nuclear medicine m ethods are available. This article focuses on the possible results of conve ntional plain radiography and tomography, computed tomography and magnetic resonance imaging as radiological methods and on bone scan, autologous whit e blood cell scintigraphy with In-111-oxin or Tc-99m-HMPAO, antigranulocyte antibodies, Tc-99m-/In-111-human immunoglobulin, Ga-67-citrate and Tc-99m- nanocolloids. Results, Different methods offer different answers. Radiological methods gi ve detailed pathological answers, nuclear medicine methods answer questions of specificity such as leukocytic infiltration. Conclusions. If osteomyelitis is suspected, plain radiography should be the first, three phase bone scintigraphy the second and infection specific rad iopharmaceuticals the third step of examination. Only in negative images wi th high clinical suspicion CT or MRI should be the final imaging procedure. In the diabetic foot imaging cascade should also start with plain radiogra phy, followed by three phase bone scintigraphy or MRI. If clinically neurop athy is present specific nuclear medicine imaging should be performed.