Diagnostic imaging
Radiographic features are as follows:
- radiographs may show only soft tissue swelling for the first two weeks
- periosteal new bone formation is visible by the end of the second week. Later, the sequestrum becomes rarefied and ragged
- neighbouring bone may become sclerotic - for example the femoral head scleroses during osteomyelitis of the proximal femur, suggesting avascularity of the sclerotic bone and possible necrosis
Other imaging includes:
- ultrasound may be very useful in localising subperiostial pus and guiding needle aspiration
- bone scan using 99m-Tc diphosphonates is very sensitive for osteomyelitis at all stages. Indium-labelled leukocytes may be more specific for infection
- MRI can distinguish pus from blood and may be helpful
- a meta-analysis found that MRI performed well in the diagnosis of osteomyelitis of the foot and ankle and can be used to rule in or rule out the diagnosis.
- magnetic resonance imaging performance was markedly superior to that of technetium Tc 99m bone scanning, plain radiography, and white blood cell studies
- a meta-analysis found that MRI performed well in the diagnosis of osteomyelitis of the foot and ankle and can be used to rule in or rule out the diagnosis.
Reference:
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