Assessment of Diabetic foot with different nuclear procedures

Diabetic foot is one of the major complications occurring in a patient with diabetes. A quick and early diagnosis of the diabetic foot is essential so as to provide early intervention. Without early intervention, this may lead to amputation of the limb affected. A clinical diagnosis is essential at first; the history should be taken about the ulcer, concentrating on the symptoms of neuropathy and peripheral artery disease. On visual examination, alterations can be seen on the affected limb. Upon palpation, (with a pair of sterilized gloves) the temperature can be felt (Coolness, and a decrease pulse, usually indicates peripheral artery disease, while warmth indicates neuropathy). Also, inflammatory markers should be checked to exclude infection, as well as presence of pus. These signs and symptoms are not quite specific and cannot distinguish a wound due to an active infection or a complication. This therefore warrants further investigations. At this point, the plain radiography is the cheapest and most readily available investigative modality that can depict bone abnormalities, though it cannot detect if an ulcer is complicated by osteomyelitis. In some cases, plain radiography is negative but clinical signs suggest otherwise. In such situations, a Magnetic resonance imaging (MRI) is recommended. Though expensive, it has a very high sensitivity for bone and soft-tissue infections, and is widely regarded as the best imaging method. The Computer tomography can also image numerous soft tissue structures and bony articulations but has the side effect of exposing the patient to large doses of radiation. Ultrasound imaging is usually used in cases of Peripheral artery diseases to check the patency of the vessels and determine the severity in the reduction of blood flow to the limb affected. Ultrasound is cost-effective but requires specialized expertise and sophisticated equipment. Nuclear imaging techniques or radionuclide scans are suggested in cases where the abovementioned procedures have not provided satisfying results. If MR imaging findings are positive, 18F-FDG PET-CT is indicated owing to its far greater specificity. This utilizes a radiolabelled glucose molecule to determine highly metabolic cells (such as tumor cells). This is because highly metabolically active cells increase their uptake of glucose. In combination with PET-CT. This provides a number of advantages compared to other techniques such as optimal spatial resolution, accurate anatomical localization of abnormalities, rapid diagnostic results, and whole-body analysis. Also leukocytes can be labelled with isotopes [commonly - indium-111 (In-111) and technetium-99m (Tc-99m).]. Labelled leukocytes are used mainly to image inflammatory processes since the primary cells involved in inflammatory processes are neutrophils. Studies have shown this method to have a high specificity and sensitivity and when combined with a SPECT/CT its diagnostic accuracy can be improved. Though more accurate, it has the consequence of being laborious and time consuming.egységes, osztatlanáltalános orvosango