The diagnosis of osteomyelitis of the foot in diabetes: microbiological examination vs. magnetic resonance imaging and labelled leucocyte scanning

Diabet Med. 2006 Jun;23(6):649-53. doi: 10.1111/j.1464-5491.2006.01887.x.


Aims: Foot infections and their sequelae are among the most common and severe complications of diabetes mellitus. As diabetic patients with foot infections develop osteomyelitis and may progress to amputation, early diagnosis of osteomyelitis is critical.

Methods: We compared the diagnostic values of labelled leucocyte scanning with Tc(99)m, magnetic resonance imaging (MRI) and microbiological examination of bone tissue specimens with histopathology, the definitive diagnostic procedure. Thirty-one diabetic patients with foot lesions were enrolled in the study and histopathological examination was performed in all. Patients had clinically suspected foot lesions of > or = grade 3 according to the classification of Wagner.

Results: Bone specimens were obtained for histopathological examination. Microbiology had a sensitivity of 92% and specificity of 60%. Labelled leucocyte scanning had a sensitivity of 91%, specificity of 67%, and MRI a sensitivity of 78%, specificity of 60%.

Conclusions: Microbiological examination may be as useful as and less costly than other diagnostic procedures and is the only method which can guide the choice of antibiotic therapy.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Biopsy
  • Blood Sedimentation
  • Bone Marrow / diagnostic imaging
  • Bone Marrow / immunology
  • Bone and Bones / diagnostic imaging*
  • Bone and Bones / microbiology
  • Bone and Bones / pathology
  • C-Reactive Protein / analysis
  • Diabetic Foot / diagnostic imaging
  • Diabetic Foot / immunology
  • Diabetic Foot / microbiology*
  • Female
  • Humans
  • Isotope Labeling
  • Leukocyte Count
  • Leukocytes / immunology
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Osteomyelitis / diagnosis*
  • Osteomyelitis / immunology
  • Osteomyelitis / microbiology
  • Radionuclide Imaging
  • Radiopharmaceuticals
  • Sensitivity and Specificity
  • Technetium Tc 99m Exametazime
  • Technetium Tc 99m Medronate


  • Radiopharmaceuticals
  • Technetium Tc 99m Exametazime
  • C-Reactive Protein
  • Technetium Tc 99m Medronate