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新发传染病电子杂志 ›› 2025, Vol. 10 ›› Issue (5): 79-85.doi: 10.19871/j.cnki.xfcrbzz.2025.05.015

• 综述 • 上一篇    下一篇

糖尿病足骨髓炎的影像学研究进展

孙文雪, 赖声远, 罗佳文   

  1. 大连医科大学附属第二医院放射科,辽宁 大连 116000
  • 收稿日期:2025-02-01 发布日期:2025-11-17
  • 通讯作者: 罗佳文, Email:kaoyan2006succeed@163.com
  • 基金资助:
    辽宁省科学技术计划(2024-MSLH-083)

Advances in imaging studies of diabetic foot osteomyelitis

Sun Wenxue, Lai Shengyuan, Luo Jiawen   

  1. Department of Radiology, the Second Hospital of Dalian Medical University, Liaoning Dalian 116000, China
  • Received:2025-02-01 Published:2025-11-17

摘要: 糖尿病足是糖尿病患者常见的严重并发症之一,主要由神经病变和外周动脉病变引发。随着疾病进展,患者逐渐发生糖尿病足感染(diabetic foot infection,DFI)和糖尿病足骨髓炎(diabetic foot osteomyelitis,DFO),后者常需要进行下肢截肢,严重影响患者的生活质量。影像学检查在DFO的早期诊断中发挥着至关重要的作用。X线片在初步筛查和随访中具有一定价值。MRI诊断DFO的准确性和敏感性较高,但存在检查禁忌证。18F-氟代脱氧葡萄糖正电子发射计算机断层显像/X线计算机断层显像(18F-fluorodeoxyglucose positron emission tomography/computed tomography,18F-FDG PET/CT)具有较高的敏感度,但检查成本高且临床普及率相对较低,一定程度上限制其在临床上的广泛应用。相比之下,结合不同技术的单光子发射计算机断层显像/计算机断层显像(single-photon emission computed tomography/computed tomography,SPECT/CT)在DFO的诊断中提供了更便捷和安全的选择,且能够评估感染的位置和范围。超声检查具有临床普及率高和检查费用较低的优势,但诊断效能很大程度上依赖操作者的经验,具有较大的变异性。此外,双能CT(dual-energy CT,DECT)作为新兴影像检查技术,在中足和后足区域显示出良好的诊断潜力。本文总结了近年来文献报道的不同影像检查方法在DFO诊断中的适应证、诊断效能及临床局限性,以期为临床医生选择合适的影像检查方法提供参考依据,进而提高DFO早期诊断率,改善患者预后。

关键词: 糖尿病足, 糖尿病足骨髓炎, 影像学

Abstract: Diabetic foot is one of the common and severe complications faced by diabetic patients, primarily caused by neuropathy and peripheral arterial disease. As the disease progresses, patients gradually develop diabetic foot infections and diabetic foot osteomyelitis(DFO), the latter often necessitating lower limb amputation, which severely impacts the quality of life of patients. Imaging examinations play a crucial role in the early diagnosis of DFO. X-rays have certain value in initial screening and follow-up, while MRI offers higher accuracy and sensitivity in diagnosing DFO, although there are contraindications for the examination. 18F-fluorodeoxyglucose positron emission tomography/computed tomography(18F-FDG PET/CT)has high sensitivity. However, its high cost and relatively low clinical prevalence somewhat limit its widespread clinical application. In comparison, single-photon emission computed tomography/computed tomography (SPECT/CT) combining different technologies offers a more convenient and safe option for diagnosing DFO, and can effectively evaluate the location and extent of the infection. Ultrasound examination has the advantages of high clinical prevalence and lower examination costs, but its diagnostic efficacy largely depends on the operator's experience, leading to considerable variability. Additionally, dual-energy CT (DECT), as an emerging imaging technology, has shown promising diagnostic potential in the midfoot and hindfoot regions. This article summarizes the indications, diagnostic efficacy, and clinical limitations of various imaging examination methods reported in recent literature for the diagnosis of DFO, aiming to provide clinicians with a reference for selecting appropriate imaging examination methods, thereby improving the early diagnosis rate of DFO and enhancing patient prognosis.

Key words: Diabetic foot, Diabetic foot osteomyelitis, Imaging

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