The Spanish Society of Nuclear Medicine and Molecular Imaging (SEMNIM) has called for intensifying the training of professionals in the management of molecular imaging techniques, in order to make the most of their usefulness in caring for patients with diabetic foot.
Coinciding with the observance of World Diabetes Day this Saturday, the society has emphasized that these imaging tools are key for clarifying diagnostic questions when other examinations are not conclusive and, specifically, for determining whether the infection in the diabetic foot has reached the bone.
The head of the Nuclear Medicine Service at the Hospital Universitario de Guadalajara, Edel Noriega Álvarez, has said that this type of knowledge is essential for guiding treatment decisions and preserving as much healthy tissue as possible, as well as the function of the foot.
As indicated by the scientific society, infection of the bone, called osteomyelitis, can be complex to diagnose and to distinguish from non-infectious changes when the foot has preexisting alterations, such as fractures, surgical interventions, or the so-called Charcot foot, a complication of diabetes that affects bones and joints.
A correct identification of whether the bone is affected and the exact location of the infection helps to decide which samples should be obtained, which antibiotic is most appropriate, and how to organize a possible surgical intervention.
Scintigraphy and PET/CT in the diabetic foot
In this context, nuclear medicine has specific studies that make it possible to detect and locate areas with inflammatory or infectious activity. These include leukocyte scintigraphy with labeled white blood cells and positron emission tomography combined with computed tomography (PET/CT), which integrate functional and anatomical information to help differentiate a bone infection from other conditions.
The use of these techniques is especially valuable when magnetic resonance imaging is not possible or its findings do not allow a firm diagnosis to be established. "Not all patients with diabetic foot need them: they are indicated in response to a specific clinical question," Noriega has clarified.
Despite its relevance, the Spanish Society of Nuclear Medicine and Molecular Imaging has warned that the shortage of specialists and insufficient organization of resources determine the availability of some procedures, in particular those that require the labeling of leukocytes.
A survey by the Working Group on Musculoskeletal Pathology of SEMNIM, prepared using data from 2021 from 34 Spanish hospitals, revealed differences in image acquisition protocols and gaps in specific training. For this reason, the unification of diagnostic criteria, the optimization of referral pathways, and the promotion of multidisciplinary work were identified as priority lines.
In this context, SEMNIM has emphasized the importance of advancing toward a more uniform use of molecular imaging techniques, by strengthening specialized training and promoting shared diagnostic criteria that make it possible to provide more precise and coordinated care to people with diabetes.