{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T16:05:11Z","timestamp":1793462711426,"version":"4.5.0"},"reference-count":28,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2024,8,22]],"date-time":"2024-08-22T00:00:00Z","timestamp":1724284800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Italian Ministry of Health (Ricerca Corrente to IRCCS INRCA)"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Tomography"],"abstract":"<jats:p>Background: Distinguishing between Charcot Neuroarthropathy (CN), osteomyelitis (OM), and CN complicated with superimposed OM in diabetic patients is crucial for the treatment choice. Given that current diagnostic methods lack specificity, advanced techniques, e.g., magnetic resonance imaging (MRI) and 99mTc-HMPAO\u2013WBC Single Photon Emission Computed Tomography (SPECT\/CT), are needed. This study addresses the challenges in distinguishing OM and CN. Methods: We included diabetic patients with CN and soft tissue ulceration. MRI and 99mTc-HMPAO\u2013WBC SPECT\/CT were used for the diagnosis. The patients were classified into three probability levels for OM (i.e., Definite, Probable, and Unlikely) according to the Consensus Criteria for Diabetic Foot Osteomyelitis (CC-DFO). Results: Eight patients met the eligibility criteria. MRI, supported by SPECT-CT and CC-DFO, showed consistency with the OM diagnosis in three cases. The key diagnostic features included the location of signal abnormalities and secondary features such as skin ulcers, sinus tracts, and abscesses. Notably, cases with inconclusive MRI were clarified by SPECT\/CT, emphasizing its efficacy in challenging scenarios. Conclusions: The primary objective of this study was to compare the results of MRI and 99mTc-HMPAO\u2013WBC SPECT\/CT with the CC-DFO score in the diabetic foot with CN and suspected OM. Advanced imaging offers a complementary approach to distinguish between CN and OM. This can help delineate the limits of the disease for presurgical planning. While MRI is valuable, 99mTc-HMPAO\u2013WBC SPECT\/CT provides additional clarity, especially in challenging cases or when metallic implants affect MRI accuracy.<\/jats:p>","DOI":"10.3390\/tomography10080098","type":"journal-article","created":{"date-parts":[[2024,8,27]],"date-time":"2024-08-27T11:58:46Z","timestamp":1724759926000},"page":"1312-1319","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Magnetic Resonance Imaging and 99Tc WBC-SPECT\/CT Scanning in Differential Diagnosis between Osteomyelitis and Charcot Neuroarthropathy: A Case Series"],"prefix":"10.3390","volume":"10","author":[{"given":"Sara","family":"Cecchini","sequence":"first","affiliation":[{"name":"Department of Radiology, IRCCS INRCA, 60127 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Gatti","sequence":"additional","affiliation":[{"name":"Diabetic Foot Clinics, IRCCS INRCA, 60127 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"Fornarelli","sequence":"additional","affiliation":[{"name":"Unit of Nuclear Medicine, IRCCS INRCA, 60127 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7379-7714","authenticated-orcid":false,"given":"Lorenzo","family":"Fantechi","sequence":"additional","affiliation":[{"name":"Unit of Nuclear Medicine, IRCCS INRCA, 60127 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cinzia","family":"Romagnolo","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, \u201cOspedali Riuniti\u201d Hospital, 60126 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Tortato","sequence":"additional","affiliation":[{"name":"Diabetic Foot Clinics, IRCCS INRCA, 60127 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9619-0181","authenticated-orcid":false,"given":"Anna Rita","family":"Bonfigli","sequence":"additional","affiliation":[{"name":"Scientific Direction, IRCCS INRCA, 60127 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7997-8794","authenticated-orcid":false,"given":"Roberta","family":"Galeazzi","sequence":"additional","affiliation":[{"name":"Clinic of Laboratory and Precision Medicine, IRCCS INRCA, 60127 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9606-1144","authenticated-orcid":false,"given":"Fabiola","family":"Olivieri","sequence":"additional","affiliation":[{"name":"Scientific Direction, IRCCS INRCA, 60127 Ancona, Italy"},{"name":"Department of Clinical and Molecular Sciences (DISCLIMO), Universit\u00e0 Politecnica delle Marche, 60126 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Bronte","sequence":"additional","affiliation":[{"name":"Clinic of Laboratory and Precision Medicine, IRCCS INRCA, 60127 Ancona, Italy"},{"name":"Department of Clinical and Molecular Sciences (DISCLIMO), Universit\u00e0 Politecnica delle Marche, 60126 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3448-9345","authenticated-orcid":false,"given":"Enrico","family":"Paci","sequence":"additional","affiliation":[{"name":"Department of Radiology, IRCCS INRCA, 60127 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,8,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"437","DOI":"10.7547\/1010437","article-title":"The Charcot foot in diabetes","volume":"101","author":"Rogers","year":"2011","journal-title":"J. Am. Podiatr. Med. Assoc."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"S145","DOI":"10.1002\/dmrr.836","article-title":"Diabetic foot osteomyelitis: A progress report on diagnosis and a systematic review of treatment","volume":"24","author":"Berendt","year":"2008","journal-title":"Diabetes Metab. Res. Rev."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.cpm.2007.10.001","article-title":"Epidemiology of the Charcot foot","volume":"25","author":"Frykberg","year":"2008","journal-title":"Clin. Podiatr. Med. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"21855","DOI":"10.3402\/dfa.v4i0.21855","article-title":"Osteomyelitis or Charcot neuro-osteoarthropathy? Differentiating these disorders in diabetic patients with a foot problem","volume":"4","author":"Ertugrul","year":"2013","journal-title":"Diabet. Foot Ankle."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"888","DOI":"10.1086\/597263","article-title":"Needle puncture and transcutaneous bone biopsy cultures are inconsistent in patients with diabetes and suspected osteomyelitis of the foot","volume":"48","author":"Senneville","year":"2009","journal-title":"Clin. Infect. Dis."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1111\/j.1464-5491.2011.03414.x","article-title":"Outcome of patients with diabetes with negative percutaneous bone biopsy performed for suspicion of osteomyelitis of the foot","volume":"29","author":"Senneville","year":"2012","journal-title":"Diabet. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"944","DOI":"10.1093\/cid\/ciw445","article-title":"Diagnostic Accuracy of Probe to Bone to Detect Osteomyelitis in the Diabetic Foot: A Systematic Review","volume":"63","author":"Lam","year":"2016","journal-title":"Clin. Infect. Dis."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1111\/iwj.12574","article-title":"Erythrocyte sedimentation rate and C-reactive protein to monitor treatment outcomes in diabetic foot osteomyelitis","volume":"14","author":"Jupiter","year":"2017","journal-title":"Int. Wound J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"201","DOI":"10.2337\/diacare.17.3.201","article-title":"Radiographic abnormalities in the feet of patients with diabetic neuropathy","volume":"17","author":"Cavanagh","year":"1994","journal-title":"Diabetes Care."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"775","DOI":"10.1016\/j.fcl.2006.06.008","article-title":"Osteomyelitis in the diabetic foot: Diagnosis and management","volume":"11","author":"Shank","year":"2006","journal-title":"Foot Ankle Clin."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"S115","DOI":"10.1086\/383272","article-title":"Controversies in diagnosing and managing osteomyelitis of the foot in diabetes","volume":"39","author":"Jeffcoate","year":"2004","journal-title":"Clin. Infect. Dis."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1105","DOI":"10.1016\/j.rcl.2008.08.004","article-title":"Current concepts in imaging diabetic pedal osteomyelitis","volume":"46","author":"Donovan","year":"2008","journal-title":"Radiol. Clin. N. Am."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"b4690","DOI":"10.1136\/bmj.b4690","article-title":"Rational Imaging. Investigating suspected bone infection in the diabetic foot","volume":"339","author":"Teh","year":"2009","journal-title":"BMJ"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1270","DOI":"10.2174\/1381612824666180227094116","article-title":"Leukocyte Imaging of the Diabetic Foot","volume":"24","author":"Lauri","year":"2018","journal-title":"Curr. Pharm. Des."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1042","DOI":"10.2967\/jnumed.108.059493","article-title":"Diabetic foot infection: Usefulness of SPECT\/CT for 99mTc-HMPAO-labeled leukocyte imaging","volume":"50","author":"Filippi","year":"2009","journal-title":"J. Nucl. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1016\/j.ocl.2016.12.011","article-title":"Charcot Arthropathy Versus Osteomyelitis: Evaluation and Management","volume":"48","author":"Womack","year":"2017","journal-title":"Orthop. Clin. North Am."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1177\/1534734614545875","article-title":"Confronting a dramatic situation: The charcot foot complicated by osteomyelitis","volume":"13","year":"2014","journal-title":"Int. J. Low Extrem. Wounds"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Expert Panel on Musculoskeletal Imaging, Walker, E.A., Beaman, F.D., Wessell, D.E., Cassidy, R.C., Czuczman, G.J., Demertzis, J.L., Lenchik, L., Motamedi, K., and Pierce, J.L. (2019). ACR Appropriateness Criteria\u00ae Suspected Osteomyelitis of the Foot in Patients with Diabetes Mellitus. J. Am. Coll. Radiol., 16, S440\u2013S450.","DOI":"10.1016\/j.jacr.2019.05.027"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1001\/archinte.167.2.125","article-title":"Magnetic resonance imaging for diagnosing foot osteomyelitis: A meta-analysis","volume":"167","author":"Kapoor","year":"2007","journal-title":"Arch. Intern. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"939","DOI":"10.1259\/bjr\/30036666","article-title":"MRI of the diabetic foot: Differentiation of infection from neuropathic change","volume":"80","author":"Tan","year":"2007","journal-title":"Br. J. Radiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1055\/s-2005-921945","article-title":"Differential diagnosis of pedal osteomyelitis and diabetic neuroarthropathy: MR Imaging","volume":"9","author":"Ledermann","year":"2005","journal-title":"Semin. Musculoskelet. Radiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"21884","DOI":"10.3402\/dfa.v4i0.21884","article-title":"Charcot foot in diabetes and an update on imaging","volume":"4","author":"Ergen","year":"2013","journal-title":"Diabet. Foot Ankle"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1016\/j.rcl.2005.02.008","article-title":"MR imaging of the diabetic foot: Diagnostic challenges","volume":"43","author":"Chatha","year":"2005","journal-title":"Radiol. Clin. North Am."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1161","DOI":"10.1148\/rg.2017160101","article-title":"Advanced MR Imaging Techniques for Differentiation of Neuropathic Arthropathy and Osteomyelitis in the Diabetic Foot","volume":"37","author":"Vilanova","year":"2017","journal-title":"Radiographics"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1760","DOI":"10.1007\/s00259-013-2481-0","article-title":"A large retrospective single-centre study to define the best image acquisition protocols and interpretation criteria for white blood cell scintigraphy with 99mTc-HMPAO-labelled leucocytes in musculoskeletal infections","volume":"40","author":"Glaudemans","year":"2013","journal-title":"Eur. J. Nucl. Med. Mol. Imaging"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"615","DOI":"10.1007\/s00259-013-2631-4","article-title":"Image acquisition and interpretation criteria for 99mTc-HMPAO-labelled white blood cell scintigraphy: Results of a multicenter study","volume":"41","author":"Erba","year":"2014","journal-title":"Eur. J. Nucl. Med. Mol. Imaging"},{"key":"ref_27","first-page":"271","article-title":"Comparison Between Tc-99m WBC SPECT\/CT and MRI for the Diagnosis of Biopsy-proven Diabetic Foot Osteomyelitis","volume":"28","author":"Bhavan","year":"2016","journal-title":"Wounds"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"109215","DOI":"10.1016\/j.ejrad.2020.109215","article-title":"Imaging for detection of osteomyelitis in people with diabetic foot ulcers: A systematic review and meta-analysis","volume":"131","author":"Llewellyn","year":"2020","journal-title":"Eur. J. Radiol."}],"container-title":["Tomography"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2379-139X\/10\/8\/98\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T15:40:46Z","timestamp":1760110846000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2379-139X\/10\/8\/98"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,22]]},"references-count":28,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2024,8]]}},"alternative-id":["tomography10080098"],"URL":"https:\/\/doi.org\/10.3390\/tomography10080098","relation":{},"ISSN":["2379-139X"],"issn-type":[{"value":"2379-139X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,8,22]]}}}