Novel advanced imaging method to differentiate acute osteomyelitis from acute charcot neuroarthropathy in the presence of chronic ulcer: A case series

Charcot neuroarthropathy presents a diagnostic challenge and is complicated by chronic ulceration, as radiographic and histological findings are similar to osteomyelitis. Traditional techniques for diagnosis, such as bone biopsy and magnetic resonance imaging, lack specificity when attempting to differentiate between these two entities. In our prior case report, it was found that utilizing a comprehensive nuclear medicine imaging protocol starting with a bone scan utilizing Technetium-99 m methyl diphosphonate with single photon emission computed tomography-computed tomography (SPECT/CT) followed by an additional nuclear medicine study utilizing indium-111 labeled white blood cells and Technetium-99 m sulfur colloid with single photon emission computed tomography-computed tomography allowed differentiation between these two entities. This case series utilized this protocol and found that it allows for differentiation between these two entities even after Charcot reconstructions with chronic ulcerations. This protocol allows for improved diagnostic specificity and surgical planning for complex limb salvage.