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Detection of Osteomyelitis Associated With Diabetic Foot Ulcers-Reply

Lisa G. Newman, MD; John Waller, MD; Christopher J. Palestro, MD; Myron Schwartz, MD; Michael J. Klein, MD; George Hermann, MD; Martin Harrington, MD; Elizabeth Harrington, MD; Sheila H. Roman, MD; Alex Stagnaro-Green, MD
JAMA. 1992;267(4):510-511. doi:10.1001/jama.1992.03480040058027.
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In Reply.  —Our conclusion that leukocyte scanning can distinguish between soft tissue and bone infection is supported by the low false-positive (10%) and false-negative (7%) rates found in our study when these scans were compared with bone biopsy, as well as by others.2 As noted in our "Methods" section, osteomyelitis was diagnosed only when focal uptake was seen on both plantar and dorsal views. As the ulcers were confined to the plantar surface, uptake would not be expected on the dorsal view if only the soft tissues were infected. Orthogonal views may be necessary only in the case of tarsal osteomyelitis as the thickness of the foot alone may preclude increased uptake on both plantar and dorsal views even when bony infection is present. These views were performed in the three patients with calcaneus osteomyelitis in our study.We agree that bone scans may not be accurate in


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