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Diagnostic imaging

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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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

Reference:

  1. Kapoor A et al. Magnetic resonance imaging for diagnosing foot osteomyelitis: a meta-analysis. Arch Intern Med. 2007 Jan 22;167(2):125-32

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