Evaluation of benefit of low dose CT in the diagnosis of charcot arthropathy

Abstract

Diabetes mellitus (DM) is accompanied by many complications (nephropathy, neuropathy, ischemic heart disease etc.), while the foot ulcer falls among the most serious ones. The main problem for the right diagnosis of this syndrome is an appropriate choice of a diagnostic scenario. The aim of this study is to analyse the current possibilities of DM diagnostics using particular imaging modalities, and to compare them with a three-phase skeletal scintigraphy complemented by a low-dose CT. The principal method of this work was the cost effectiveness (C/E) analysis of individual diagnostic modalities in relation to a timely detection of the disease completed by a sensitivity analysis. The result of a multiple-criteria decision analysis calculated by means of the TOPSIS method was used as the effect for the C/E calculation. Nine basic criteria entered the analysis. The values of the final effects of individual modalities are in favour of the skeletal scintigraphy and the leucoscan plus the low-dose CT. Furthermore, total costs were calculated for individual diagnostic approaches from the perspectives of a medical facility and of a health insurance company. In both cases, the lowest costs were reached for the magnetic resonance, which has also significantly influenced the final value of the cost effectiveness. In the sensitivity analysis, variations in the skeletal scintigraphy and/or leukoscan sensitivity did not affect the final order of the diagnostic modalities provided unchanged weights of the criteria. The same conclusion was also in the case of the magnetic resonance. A change in the order was detected for the skeletal scintigraphy with the low-dose CT and for the leukoscan in the case of a decrease in specificity by 40 or more percent. The study opens a topical issue and forms a basis for a broader discussion concerning Charcot osteoarthropathy diagnostics within the professional community.