Osteomyelitis is a serious health problem that results in multiple limb amputations annually. This article reviews the current scintigraphic procedures used in the diagnosis of osteomyelitis and discusses some of the newer radiopharmaceuticals now being developed. The goal is to understand the strengths and weaknesses of each method so that the procedure most effective for specific clinical settings can be selected. In general, the three-phase bone scan is the procedure of choice if the suspected osteomyelitis is not superimposed on another disease that causes increased bone remodeling (i.e., findings on the radiograph are normal). If the suspected osteomyelitis is superimposed on a disease that causes increased bone remodeling, the combined 111In-labeled leukocyte-99mTc bone scan is the procedure of choice in the non-marrow-containing skeleton and the 111In-labeled leukocyte and 99mTc bone marrow scans are the procedures of choice in the marrow-containing skeleton.

The scintigraphic diagnosis of osteomyelitis.

Osteomyelitis can be difficult to diagnose and there has previously not been a prospective approach to identify all children in a defined geographic area. The aim of this study was to assess the annual incidence of osteomyelitis in children, describe the patient and disease characteristics in those with acute (< 14 days disease duration) and subacute osteomyelitis (≥ 14 days disease duration), and differentiate osteomyelitis patients from those with other acute onset musculoskeletal features. In a population-based Norwegian study physicians were asked to refer all children with suspected osteomyelitis. Children with osteomyelitis received follow-up at six weeks, six months and thereafter as long as clinically needed. The total annual incidence rate of osteomyelitis was 13 per 100 000 (acute osteomyelitis 8 and subacute osteomyelitis 5 per 100 000). The incidence was higher in patients under the age of 3 than in older children (OR 2.9, 95%: CI 2.3–3.7). The incidence of non-vertebral osteomyelitis was higher than the incidence of vertebral osteomyelitis (10 vs. 3 per 100 000; p = .002). Vertebral osteomyelitis was more frequent in girls than in boys (OR 7.0, 95%: CI 3.3–14.7). ESR ≥ 40 mm/hr had the highest positive predictive laboratory value to identify osteomyelitis patients at 26% and MRI had a positive predictive value of 85%. Long-bone infection was found in 16 (43%) patients. ESR, CRP, white blood cell count, neutrophils and platelet count were higher for patients with acute osteomyelitis than for patients with subacute osteomyelitis. Subacute findings on MRI and doctor's delay were more common in subacute osteomyelitis than in acute osteomyelitis patients. Blood culture was positive in 26% of the acute osteomyelitis patients and was negative in all the subacute osteomyelitis patients. The annual incidence of osteomyelitis in Norway remains high. ESR values and MRI scan may help to identify osteomyelitis patients and differentiate acute and subacute osteomyelitis.

/pdf/childhood-osteomyelitis-incidence-and-differentiation-from-3l9on2245i.pdf

Childhood osteomyelitis-incidence and differentiation from other acute onset musculoskeletal features in a population-based study

The bone scan.

Fourteen diabetic patients with suspected foot infection and/or neuropathic joint (Charcot Joint) were evaluated with magnetic resonance imaging (MRI) in an attempt to assess the extent of the infection and also to distinguish infection from the changes seen with neuroarthropathy The majority of patients with infection had more than one site of involvement and the following diagnoses were made by MRI evaluation: osteomyelitis (n = 8), abscess (n = 7), neuropathic joint (n = 5), septic arthritis (n = 4), and tenosynovitis (n = 4) Clinical or surgical/pathological confirmation of the MRI diagnoses was obtained in all but nine sites of infection or cases of neuropathic joint If the two diagnostic categories of septic arthritis and tenosynovitis are excluded, all but four of the MRI diagnoses were confirmed A distinctive pattern for neuroarthropathy was identified in five cases, consisting of low signal intensity on T1- and T2-weighted images within the bone marrow space adjacent to the involved joint We conclude that MRI is a valuable adjunct in the evaluation of the diabetic foot, and that it provides accurate information regarding the presence and extent of infection in this subset of patients MRI has proven particularly helpful in differentiating neuroarthropathy from osteomyelitis

The diabetic foot: magnetic resonance imaging evaluation.

Chronic osteomyelitis is recognised as a very old disease, but acute osteomyelitis appears to have been understood only in the last 50 or so years. Until the latter part of the nineteenth century, acute osteomyelitis was only rarely recognised, except as a complication of open fractures or local sepsis. According to Wilensky (1927) the term osteomyelitis was probably coined by Nelaton in 1844. Acute osteomyelitis has always been a serious disease because of the risk to the life of the patient as well as its tendency to chronicity and recurrence. Recent improvements in surgical care and chemotherapy have made it less

Acute haematogenous osteomyelitis in infancy and childhood

99mTc-pyrophosphate studies in 21 children with acute hematogenous osteomyelitis were compared with radiographic, clinical and surgical findings. Eleven 99mTc studies revealed obvious abnormalities, four showed subtle abnormalities, two were misleading, and four were normal. No consistent explanation for the lack of positive radionuclide findings was found. We concluded that pediatric osteomyelitis presents a spectrum of scintigraphic appearances and interpretation is often difficult.

Problems in the scintigraphic detection of osteomyelitis in children.

/sup 99m/Tc pyrophosphate studies in 21 children with acute hematogenous osteomyelitis were compared with radiographic, clinical and surgical findings. Eleven /sup 99m/Tc studies revealed obvious abnormalities, four showed subtle abnormalities, two were misleading, and four were normal. No consistent explanation for the lack of positive radionuclide findings was found. We concluded that pediatric osteomyelitis presents a spectrum of scintigraphic appearances and interpretation is often difficult.

Problems in the scintigraphic detection of osteomyelitis in children. [/sup 99m/Tc-pyrophosphate]

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Problems in the scintigraphic detection of osteomyelitis in children.

Problems in the scintigraphic detection of osteomyelitis in children. [/sup 99m/Tc-pyrophosphate]