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Open AccessArticle

The Role of Bone Scintigraphy with SPECT/CT in the Characterization and Early Diagnosis of Stage 0 Charcot Neuroarthropathy

1
Department of Orthopedics, King’s College Hospital, London SE5 9RS, UK
2
Diabetic Foot Clinic, King’s College Hospital, London SE5 9RS, UK
3
Department of Diabetes, Faculty of Life Sciences and Medicine, King’s College, London SE5 9RS, UK
4
Department of Nuclear Medicine, King’s College Hospital, London SE5 9RS, UK
*
Author to whom correspondence should be addressed.
Joint senior authors: Gill Vivian and Michael Edmonds.
J. Clin. Med. 2020, 9(12), 4123; https://doi.org/10.3390/jcm9124123
Received: 1 October 2020 / Revised: 9 November 2020 / Accepted: 13 November 2020 / Published: 21 December 2020
We describe the use of Single Photon Emission Computed Tomography/Computed Tomography (SPECT/CT) in the investigation and diagnosis of Charcot neuroarthropathy (CN) in patients with a hot swollen foot but normal radiographs and clinical suspicion of CN, usually termed Stage 0. This was a retrospective cohort review of 46 diabetes patients who underwent 3 phase bone scintigraphy with “High Resolution” SPECT/CT. The imaging demonstrated that Stage 0 Charcot foot has a distinct bone pathology, which can be classified into three groups: (1) fractures on Computed Tomography (CT) with accompanying focal uptake of tracer on SPECT, (2) bony abnormalities apart from fracture on CT with focal uptake of tracer on SPECT, and (3) normal CT but focal bony uptake of tracer on SPECT. The CT component of SPECT/CT detected bony fractures in 59% of patients. Early treatment with below knee cast and follow-up for 24 months showed only 4 patients who developed Stage 1 Eichenholtz Charcot foot. Our findings support the use of 3 phase bone scintigraphy with SPECT/CT in the characterization and early diagnosis of CN. Stage 0 Charcot foot has a distinct bone pathology which requires urgent treatment to prevent progression to Stage 1 Eichenholtz Charcot foot. If SPECT/CT is unavailable, CT alone will detect bone fracture in 59% patients. View Full-Text
Keywords: SPECT/ CT; Charcot neuroarthropathy; Stage 0 Charcot neuroarthropathy; diabetes; fracture SPECT/ CT; Charcot neuroarthropathy; Stage 0 Charcot neuroarthropathy; diabetes; fracture
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MDPI and ACS Style

Ahluwalia, R.; Bilal, A.; Petrova, N.; Boddhu, K.; Manu, C.; Vas, P.; Bates, M.; Corcoran, B.; Reichert, I.; Mulholland, N.; Kavarthapu, V.; Vivian, G.; Edmonds, M. The Role of Bone Scintigraphy with SPECT/CT in the Characterization and Early Diagnosis of Stage 0 Charcot Neuroarthropathy. J. Clin. Med. 2020, 9, 4123. https://doi.org/10.3390/jcm9124123

AMA Style

Ahluwalia R, Bilal A, Petrova N, Boddhu K, Manu C, Vas P, Bates M, Corcoran B, Reichert I, Mulholland N, Kavarthapu V, Vivian G, Edmonds M. The Role of Bone Scintigraphy with SPECT/CT in the Characterization and Early Diagnosis of Stage 0 Charcot Neuroarthropathy. Journal of Clinical Medicine. 2020; 9(12):4123. https://doi.org/10.3390/jcm9124123

Chicago/Turabian Style

Ahluwalia, Raju; Bilal, Ahmad; Petrova, Nina; Boddhu, Krishna; Manu, Chris; Vas, Prashanth; Bates, Maureen; Corcoran, Ben; Reichert, Ines; Mulholland, Nicola; Kavarthapu, Venu; Vivian, Gill; Edmonds, Michael. 2020. "The Role of Bone Scintigraphy with SPECT/CT in the Characterization and Early Diagnosis of Stage 0 Charcot Neuroarthropathy" J. Clin. Med. 9, no. 12: 4123. https://doi.org/10.3390/jcm9124123

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