Background: Diagnosing diabetic foot infection is often difficult, despite several available diagnostic
methods. Amongst these, several imaging modalities exist to evaluate the diabetic foot in case of a suspected
osteomyelitis. Nuclear Medicine, in particular, offers a variety of radiopharmaceuticals and techniques. Nowadays
the gold standard radionuclide procedure, when an osteomyelitis is suspected, is represented by the use of
radiolabelled leukocytes with either 99mTc-HMPAO or 111In-oxine.
Methods: In this review, we describe the correct acquisition and interpretation of white blood cell scintigraphy
and we provide an overview of the existing literature data of the use of this technique in the infected diabetic foot.
If images are correctly acquired, displayed and interpreted, this modality reaches very high diagnostic accuracy
(>95%) in detecting osteomyelitis and it allows the differential diagnosis with a soft tissue infection or inflammation.
Single-photon emission computed tomography/computed tomography (SPECT/CT) in addition to planar
images is mandatory to determine the extent and exact location of the infective process in both fore foot and midhint
foot. With the addition of bone marrow scintigraphy using radiolabelled nanocolloids, radiolabelled white
blood cell scintigraphy is also able to differentiate between Charcot neuroarthropathy and osteomyelitis, which is
a challenge in the evaluation of diabetic foot. Radiolabelled anti-granulocyte monoclonal antibodies and their
fragments can also be used instead of white blood cells although there is a limited experience on their usefulness
in diabetic foot infection.