Diagnostic imaging
Plain radiographs show bone resorption at the site of infection with thickening and sclerosis of surrounding bone. The thickened bone may resemble a bone tumour. Sequestrae are necrotic and appear abnormally radio-dense. A sinogram may help estimate the extent of the abscess.
Radioisotope scans using 99m-Tc diphosphonates show increased uptake at the sites of osteomyelitis. Indium- labelled leukocytes are more specific for infection.
CT and MRI are essential for surgical planning as they allow visualisation of the extent of infection and tissue destruction.
Of all the imaging modalities currently in use, MRI has the highest combined sensitivity and specificity (78% to 90% and 60 % to 90% respectively) for detecting osteomyelitis. It can detect early bone infection within 3 to 5 days of disease onset. (2)
Reference
- Hatzenbuehler J, Pulling TJ. Diagnosis and management of osteomyelitis. Am Fam Physician. 2011 Nov 01;84(9):1027-33.
- Glaudemans AWJM et al. Consensus document for the diagnosis of peripheral bone infection in adults: a joint paper by the EANM, EBJIS, and ESR (with ESCMID endorsement). Eur J Nucl Med Mol Imaging. 2019 Apr;46(4):957-70.
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