Abstract
Introduction: Diabetic foot syndrome is a serious and a complex disease which can come to an amputation. Early diagnosis of potential complications is essential for an effective therapy; scintigraphic procedures can contribute signficantly thanks to their high sensitivity and minimal invasiveness.
Methods: Properties of radiopharmacueticals, namely their tissue and celular distribution, are employed in scintigraphy. Their distribution can be detected by dynamic or static, planar or tomographic (SPECT, PET) including hybrid imaging (SPECT/CT, PET/CT).
Bone scan gives information about the blood flow to the foot, about the capillary permeability and about the metabolic activity of osteoblasts and osteoclasts. Labeled white blood cells can be used to detect an infection and an inflammation (positive chemotaxis is utilized) as well as labeled glucose (increased energy demand).
Lymphoscintigraphy can be used to detect a lymphedema. Results: Bone scintigraphy has generaly high sensitivity but low specificity.
The capability to semiquatitavely assess the metabolic rate of the bone tissue makes it possible to follow the course of the disease and the effect of the therapy by repetitive examination. Labeled leukocytes have a high specificity for an inflammation, hybrid imaging can help to differentiate cellulitis from osteomyelitis.
Lymphoscintigraphy measures a velocity of a subcutaneously injected radiocolloid transport, it can discover also subclinical disorder. The detection of an increased glucose consuption is a non-specific marker, it is used for an inflammation and an atherosclerosis.
Conclusion: Scintigraphic procedures have a great diagnostic potential in patients with a diabetic foot syndrome. Bone and labeled leukocytes scintigraphy are the most routinely used procedures.
The main advantage of scintigraphy is its low invasiveness, no contrast media and low radiation. They can be, therefore, safely used also in patients with a nephropathy and an allergy.
The close cooperation with diabetologists is neccessary for the right interpretation.