A New Natural History of Charcot Foot Clinical Evolution and Final Outcome of Stage 0 Charcot Neuroarthropathy in a Tertiary Referral Diabetic Foot Clinic

作者：Ruotolo Valeria; Di Pietro Barbara; Giurato Laura; Masala Salvatore; Meloni Marco; Schillaci Orazio; Bergamini Alberto; Uccioli Luigi^*

来源：Clinical Nuclear Medicine, 2013, 38(7): 506-509.

DOI：10.1097/RLU.0b013e318292eecb

• Charcot foot
• F-18-FDG PET/CT
• diabetes
• inflammatory process of Charcot foot

Purpose: The purpose of this study is to describe the usefulness of F-18-FDG PET/CT scanning in the diagnosis and follow-up of stage 0 Charcot foot (CNO) and CNO outcomes when therapeutic options are driven by this image modality. %26lt;br%26gt;Patients and Methods: We selected 25 out of 40 diabetic patients with an acute CNO, without any bone involvement at x-ray (stage 0 CNO). Diagnostic criteria were inflammatory clinical signs of the affected foot and skin temperature difference greater than 2-C compared with the contralateral foot (Delta T). All patients underwent x-ray, MRI, and F-18-FDG PET/CT scanning (expressed as standardized uptake value, SUVmax) at baseline (T0). All patients underwent another F-18-FDG PET/CT within 1 month after Delta T was less than 2 degrees C [clinical recovery (T1)] and again every 3 months until SUVmax was less than 2 [final recovery (T2)]; at this time, MRI confirmed the end of the inflammatory condition. %26lt;br%26gt;Results: T0 Delta T was 3.04 +/- 1.65 degrees C. All patients showed T0 SUVmax of the affected foot higher than the contralateral one (3.83 +/- 1.087 vs. 1.24 +/- 0.3; P %26lt; 0.001). At clinical recovery (T1), defined by Delta T below 2 degrees C, the inflammatory signs were no longer present (T0 vs. T1 Delta T = 3.04 +/- 1.65 vs. 0.9 +/- 0.55 degrees C; P %26lt; 0.0001). At T1, SUVmax was unchanged from T0 (3.80 +/- 1.69 vs. 3.83 +/- 1.09; P = ns). %26lt;br%26gt;At final recovery (T-2), Delta T was 0.74 +/- 0.29 degrees C (similar to T1 Delta T), while the SUVmax dropped from T1 to T2 (3.8 +/- 1.69 vs. 1.72 +/- 0.52; P %26lt; 0.0001). Standard therapy was total contact cast and removable cast walker until T2 (15.12 +/- 5.45 mo). No patient developed foot bone fractures nor had relapses during follow-up (21.75 +/- 16.7 mo). %26lt;br%26gt;Discussion: PET/CT scan allows the quantification of the inflammatory process; therefore, it may drive clinical decisions in the management of acute CNO better than clinical criteria. None of our patients developed foot bone fractures or had relapses during follow-up driven by PET/CT scan.

• 出版日期2013-7