Muscle perfusion scan for prediction of anticipated diabetic foot ulceration

Document Type : Original Article

Authors

1 Department of Nuclear Medicine, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran

2 Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran

3 Research Center for Nuclear Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran

Abstract

Introduction:We evaluated the performance of muscle perfusion scan (MPS) to assess muscle perfusion reserve (MPR) for prediction of incident diabetic foot ulcerations (DFU).
Methods: We recruited 41 diabetic patients without any history of DFU. Five mCi 99mTc-MIBI was injected intravenously during repetitive dorsal and plantar right foot flexions. Then posterior calves were imaged and the counts of the region of interests (ROI) over the right and left calves were collected. MPR was calculated as the percentage of counts of right calf ROI–counts of left calf ROI / counts of left calf ROI.  Six patients did not complete the study, 3 of them due to technical errors. Patients were followed for possible occurrence of DFU for at least 12 months.
Results: During the 563±84 (range: 309-633) days follow up period, 2 patients developed DFU (5.7%). MPR was insignificantly lower in patients who developed foot ulceration in comparison to those without foot ulceration (11.3±0.6 % vs. 63.4±40.8 %; p=0.08). The cutoff at first decile of MPR values (i.e. 16%) discriminated the patients with and without future DFU with accuracy of 92% (OR= 3; p-Value=0.005).

Conclusion: MPS is useful to detect patients with diabetes at risk for future DFU.

Keywords

Main Subjects


  1. Clayton W, Elasy TA. A review of the pathophysiology, classification, and treatment of foot ulcers in diabetic patients. Clin Diabetes 2009;27(2):52-58.
  2. Cowie CC, Rust KF, Byrd-Holt DD, Gregg EW, Ford ES, Geiss LS, Bainbridge KE, Fradkin JE. Prevalence of diabetes and high risk for diabetes using A1C criteria in the U.S. population in 1988-2006. Diabetes Care. 2010 Mar;33(3):562-8.
  3. Esteghamati A, Etemad K, Koohpayehzadeh J, Abbasi M, Meysamie A, Noshad S, Asgari F, Mousavizadeh M, Rafei A, Khajeh E, Neishaboury M, Sheikhbahaei S, Nakhjavani M. Trends in the prevalence of diabetes and impaired fasting glucose in association with obesity in Iran: 2005-2011. Diabetes Res Clin Pract. 2014 Feb;103(2):319-27.
  4. Kruse I, Edelman S. Evaluation and treatment of diabetic foot ulcers. Clin Diabetes. 2006;24(2):91-93.
  5. Boyko EJ, Ahroni JH, Stensel V, Forsberg RC, Davignon DR, Smith DG. A prospective study of risk factors for diabetic foot ulcer. The Seattle Diabetic Foot Study. Diabetes Care. 1999 Jul;22(7):1036-42.
  6. Crawford F, Inkster M, Kleijnen J, Fahey T. Predicting foot ulcers in patients with diabetes: a systematic review and meta-analysis. QJM. 2007 Feb;100(2):65-86.
  7. Monteiro-Soares M, Boyko EJ, Ribeiro J, Ribeiro I, Dinis-Ribeiro M. Risk stratification systems for diabetic foot ulcers: a systematic review. Diabetologia. 2011 May;54(5):1190-9.
  8. Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes. JAMA. 2005 Jan 12;293(2):217-28.
  9. Potier L, Abi Khalil C, Mohammedi K, Roussel R. Use and utility of ankle brachial index in patients with diabetes. Eur J Vasc Endovasc Surg. 2011 Jan;41(1):110-6.
  10. Aerden D, Massaad D, von Kemp K, van Tussenbroek F, Debing E, Keymeulen B, Van den Brande P. Pierre Van den Brande, The ankle--brachial index and the diabetic foot: a troublesome marriage. Ann Vasc Surg. 2011 Aug;25(6):770-7.
  11. Schaper NC, Andros G, Apelqvist J, Bakker K, Lammer J, Lepantalo M, Mills JL, Reekers J, Shearman CP, Zierler RE, Hinchliffe RJ; International Working Group on Diabetic foot. Specific guidelines for the diagnosis and treatment of peripheral arterial disease in a patient with diabetes and ulceration of the foot 2011. Diabetes Metab Res Rev. 2012 Feb;28 Suppl 1:236-7.
  12. Apelqvist J. Diagnostics and treatment of the diabetic foot. Endocrine. 2012 Jun;41(3):384-97.
  13. Houghton VJ, Bower VM, Chant DC. Is an increase in skin temperature predictive of neuropathic foot ulceration in people with diabetes? A systematic review and meta-analysis. J Foot Ankle Res. 2013 Aug 7;6(1):31. 
  14. Colberg SR, Parson HK, Holton DR, Nunnold T, Vinik AI. Cutaneous blood flow in type 2 diabetic individuals after an acute bout of maximal exercise. Diabetes Care. 2003 Jun;26(6):1883-8.
  15. Miles KA, Barber RW, Wraight EP, Cooper M, Appleton DS. Leg muscle scintigraphy with 99Tcm-MIBI in the assessment of peripheral vascular (arterial) disease. Nucl Med Commun. 1992 Aug;13(8):593-603.
  16. Tanaka K, Kamada H, Shimizu Y, Aikawa S, Irie S, Ochiai N, Sakane M, Yamazaki M. Muscle activity in the lower limbs during push-down movement with a new active-exercise apparatus for the leg. J Phys Ther Sci. 2016 Mar;28(3):1050-4.
  17. Gardner SE, Hillis SL, Heilmann K, Segre JA, Grice EA. The neuropathic diabetic foot ulcer microbiome is associated with clinical factors. Diabetes. 2013 Mar;62(3):923-30.
  18. Ricco JB, Thanh Phong L, Schneider F, Illuminati G, Belmonte R, Valagier A, Régnault De La Mothe G. The diabetic foot: a review. J Cardiovasc Surg (Torino). 2013 Dec;54(6):755-62.
  19. Dinh T, Tecilazich F, Kafanas A, Doupis J, Gnardellis C, Leal E, Tellechea A, Pradhan L, Lyons TE, Giurini JM, Veves A. Mechanisms involved in the development and healing of diabetic foot ulceration. Diabetes. 2012 Nov;61(11):2937-47.
  20. Abbott CA, Carrington AL, Ashe H, Bath S, Every LC, Griffiths J, Hann AW, Hussein A, Jackson N, Johnson KE, Ryder CH, Torkington R, Van Ross ER, Whalley AM, Widdows P, Williamson S, Boulton AJ; North-West Diabetes Foot Care Study. The North-West Diabetes Foot Care Study: incidence of, and risk factors for, new diabetic foot ulceration in a community-based patient cohort. Diabet Med. 2002 May;19(5):377-84.
  21. Zimering MB. Topics in the prevention, treatment and complications of type 2 diabetes. Croatia: InTech; 2011.
  22. Sayman HB, Urgancioglu I. Muscle perfusion with technetium-MIBI in lower extremity peripheral arterial diseases. J Nucl Med. 1991 Sep;32(9):1700-3.
  23. Lin CC, Ding HJ, Chen YW, Huang WT, Kao A. Usefulness of thallium-201 muscle perfusion scan to investigate perfusion reserve in the lower limbs of Type 2 diabetic patients. J Diabetes Complications. 2004 Jul-Aug;18(4):233-6.
  24. Celen YZ, Zincirkeser S, Akdemir I, Yilmaz M. Investigation of perfusion reserve using 99Tc(m)-MIBI in the lower limbs of diabetic patients. Nucl Med Commun. 2000 Sep;21(9):817-22.
  25. Hsu HB, Sun SS, Chen JJ, Tsai JJ, Kao CH, ChangLai SP. Usefulness of thallium-201 muscle scan to investigate perfusion reserve in the lower limbs of patients with systemic lupus erythematusus. Rheumatol Int. 2004 Sep;24(5):291-3. 
  26. Amin AM, Nawito ZO, Atfy RA, El-Hadidi KT. Tc-99m sestamibi lower extremity muscle scan, is it a useful screening tool for assessment of preclinical atherosclerosis in rheumatoid arthritis patients? Rheumatol Int. 2012 Jul;32(7):2075-81. 
  27. Stacy MR, Zhou W, Sinusas AJ. Radiotracer imaging of peripheral vascular disease. J Nucl Med Technol. 2015 Sep;43(3):185-92.