THE RESULTS OF MULTIPHASE OSTEOSCINTIGRAPHY IN PATIENTS WITH AN INACTIVE STAGE OF DIABETIC NEUROOSTEOARTHROPATHIES OF THE FEET (ARTHROPATHY OF CHARCOT)

Purpose: to study the radionuclide semiotics of the inactive stage of diabetic neuroosteoarthropathy. Seven patients with diabetes mellitus and diabetic neuroosteoarthropathy of one foot were included in the study. The duration of the inactive stage of diabetic neuroosteoarthropathy was from 4 to 57 months at the time of the examination. The inactivity of disease was determined by clinical and x-ray signs. Flow, blood pool and activity of the osteoblastic process in the affected foot were assessed by multiphase osteoscintigraphy with 99mTc-pyrophosphate. The intensity of uptake of the tracer in the affected foot was evaluated quantitatively based on the uptake ratio between affected and normal feet. In the first phase, reflecting the blood flow, the amplitude of «time/activity» curve in affected foot was in one and a half times higher, than in the control foot. It pointed out on the increase of total blood flow, despite the absence of an active inflammatory process. Only in one case was demonstrated symmetrical «time/activity» curves for affected and normal feet. In 5 out of 7 patients, an increase in vascular permeability was observed in the affected foot. High osteoblastic activity in the affected foot was noted in all patients. The relationship between the tracer accumulation, data of magnetic resonance imaging and the duration of the inactive stage of diabetic neuropathy were not revealed. Conclusion: the results of the pilot study demonstrated an increase of local blood flow, vascular permeability, and osteoblastic activity in patients with a long-term clinical inactive diabetic neuroosteoarthropathy. This findings shows continuous bone remodeling as well as latent aseptic inflammation of the joints and soft tissues in cases of Charcot’s arthropathy. 

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