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1
Meyr A, Singh S, Zhang X, et al: Statistical reliability of bone biopsy for the diagnosis of diabetic foot osteomyelitis. J Foot Ankle Surg 50: 663, 2011.
-
2
Pugmire BS, Shailam R, Gee MS: Role of MRI in the diagnosis and treatment of osteomyelitis in pediatric patients. World J Radiol 6: 530, 2014.
-
3
Lee YJ, Sadigh S, et al: The imaging of osteomyelitis. Quant Imaging Med Surg 6: 191, 2016.
-
4
Palestro CJ, Love C, Tronco GG, et al: Combined labeled leukocyte and technetium 99m sulfur colloid bone marrow imaging for diagnosing musculoskeletal infection. Radiographics 26: 859, 2006.
-
5
Schauwecker DS: The scintigraphic diagnosis of osteomyelitis. AJR Am J Roentgenol 158: 9, 1992.
-
6
Palestro CJ, Mehta HH, Patel M, et al: Marrow versus infection in the Charcot joint: indium-111 leukocyte and technetium-99mm sulfur colloid scintigraphy. J Nucl Med 39: 346, 1998.
-
7
Baccei BJ, Raghavan M, Smith SE: Imaging techniques for evaluation of the painful joint. UpToDate Web site. Available at: https://www.uptodate.com/contents/imaging-techniques-for-evaluation-of-the-painful-joint. Accessed February 13, 2020.
-
8
Short DJ, Zgonis T: Medical imaging in differentiating the diabetic Charcot foot from osteomyelitis. Clin Podiatr Med Surg 34: 9, 2017.
The Utility of Sulfur Colloid Imaging to Differentiate Charcot’s Neuroarthropathy from Osteomyelitis: A Case Study
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Charcot’s neuroarthropathy and osteomyelitis can have similar initial presentations. The ability to differentiate between the two pathologic conditions is essential, as each requires different treatment. We present a case of a 53-year-old woman with pain, swelling, and warmth in her left first metatarsophalangeal joint and first tarsometatarsal joint. Radiographs showed comminuted fractures at the base of the first metatarsal. Osteomyelitis was suspected by the primary team based on physical findings and a history of previous first metatarsophalangeal joint arthrodesis. A triphasic bone scan and an indium white blood cell scan were positive for osteomyelitis. The podiatric medical team was suspicious for possible Charcot’s neuroarthropathy based on physical findings and uncontrolled blood glucose levels at the time of her previous arthrodesis. A sulfur colloid scan was performed and compared with an indium scan, which showed no evidence of osteomyelitis. This case demonstrates the usefulness of sulfur colloid imaging compared with an indium white blood cell scan to differentiate osteomyelitis from Charcot’s neuroarthropathy. This case also highlights the importance of using clinical judgment to make the correct diagnosis.
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