Hybrid PET, and Magnetic Resonance Imaging Preoperative Imaging of Charcot Neuroarthropathy in Diabetic Patients: Comparison of Ring PET,

Introduction: The treatment of Charcot neuroarthropathy in the feet of diabetic patients has undergone fundamental changes in the last few years. Formerly, treatment was almost exclusively limited to nonoperative measures; since the late 1990s, however, current practice has shifted to early, stage-appropriate surgical therapy. The objective of this prospective study was to investigate the value of two types of positron emission tomography (PET) in the preoperative evaluation of diabetic patients with Charcot foot deformities. Materials and Methods: Ring [18F]FDG (2fluoro-2-deoxy-glucose) and hybrid PET were compared to magnetic resonance imaging (MRI). MRI, ring PET, and hybrid PET imaging were used as part of the preoperative evaluation of 16 patients with type II diabetes mellitus. The diagnosis of Charcot neuropathy of the foot requiring operative treatment had been made on the basis of clinical and radiographic criteria. Results: Of 39 Charcot lesions confirmed at surgery, 37 were detected by ring PET, 30 by hybrid PET, and 31 by MRI. Conclusions: PET (ring or hybrid) can be used in the evaluation of patients with metal implants that would compromise the accuracy of MRI. Another advantage of PET is its ability to distinguish between inflammatory and infectious softtissue lesions, and between osteomyelitis and Charcot 1Department of Radiology, Justus-Liebig-University of Giessen, Klinikstr. 36, 35385 Giessen, Germany Department of Nuclear Medicine, Ludwig-Maximilians-University of Munich, Ziemssenstrasse 1, 80336 Munich, Germany Department of Clinical Radiology, Ludwig-Maximilians-University of Munich, Ziemssenstrasse 1, Germany Department of Surgery, Ludwig-Maximilians-University of Munich, Nussbaumstrasse 20, 80336 Munich, Germany Corresponding Author: Dr. med. Stefan Höpfner, M.D. Department of Radiology Justus-Liebig-University of Giessen