Radiographic Imaging in Osteomyelitis: The Role of Plain Radiography, Computed Tomography, Ultrasonography, Magnetic Resonance Imaging, and Scintigraphy

 

 Buy Article Permissions and Reprints

ABSTRACT

The diagnostic imaging of osteomyelitis can require the combination of diverse imaging techniques for an accurate diagnosis. Conventional radiography should always be the first imaging modality to start with, as it provides an overview of the anatomy and the pathologic conditions of the bone and soft tissues of the region of interest. Sonography is most useful in the diagnosis of fluid collections, periosteal involvement, and surrounding soft tissue abnormalities and may provide guidance for diagnostic or therapeutic aspiration, drainage, or tissue biopsy. Computed tomography scan can be a useful method to detect early osseous erosion and to document the presence of sequestrum, foreign body, or gas formation but generally is less sensitive than other modalities for the detection of bone infection. Magnetic resonance imaging is the most sensitive and most specific imaging modality for the detection of osteomyelitis and provides superb anatomic detail and more accurate information of the extent of the infectious process and soft tissues involved. Nuclear medicine imaging is particularly useful in identifying multifocal osseous involvement.

REFERENCES

• 1 Lew D P, Waldvogel F A. Osteomyelitis.  N Engl J Med. 1997;  336 999-1007
  CrossrefPubMedGoogle Scholar
• 2 Pineda C, Vargas A, Vargas-Rodríguez A. Imaging of osteomyelitis: current concepts.  Infect Dis Clin North Am. 2006;  20 789-825
  CrossrefPubMedGoogle Scholar
• 3 Zink B. Bone and joint infections. In: Marx et al Rosen's Emergency Medicine: Concepts and Clinical Practice. New York, NY; Mosby 2006
  Google Scholar
• 4 David R, Barron B J, Madewell J E. Osteomyelitis, acute and chronic.  Radiol Clin North Am. 1987;  25 1171-1201
  PubMedGoogle Scholar
• 5 Carek P J, Dickerson L M, Sack J L. Diagnosis and management of osteomyelitis.  Am Fam Physician. 2001;  63 2413-2420
  PubMedGoogle Scholar
• 6 Waldvogel F A, Medoff G, Swart M N. Osteomyelitis: a review of clinical features, therapeutic considerations, and unusual aspects (first of three parts).  N Engl J Med. 1970;  282 198-206
  CrossrefPubMedGoogle Scholar
• 7 Waldvogel F A, Medoff G, Swartz M N. Osteomyelitis: a review of clinical features, therapeutic considerations, and unusual aspects (second of three parts).  N Engl J Med. 1970;  282 260-266
  CrossrefPubMedGoogle Scholar
• 8 Waldvogel F A, Medoff G, Swartz M N. Osteomyelitis: a review of clinical features, therapeutic considerations, and unusual aspects (third of three parts).  N Engl J Med. 1970;  282 316-322
  PubMedGoogle Scholar
• 9 Cierny III G, Mader J T, Pennick J J. A clinical staging system for adult osteomyelitis.  Clin Orthop Relat Res. 2003;  414 7-24
  PubMedGoogle Scholar
• 10 Tsukayama D T. Pathophysiology of posttraumatic osteomyelitis.  Clin Orthop Relat Res. 1999;  360 22-29
  PubMedGoogle Scholar
• 11 Resnick D, Niwayama G. Osteomyelitis, septic arthritis and soft tissue infection: mechanisms and situations. In: Resnick D Diagnosis of Bone and Joint Disorders. 3rd ed. Philadelphia, PA; WB Saunders 1995: 2325-2418
  Google Scholar
• 12 Sia I G, Berbari E F. Osteomyelitis.  Best Pract Res Clin Rheumatol. 2006;  20 1065-1081
  CrossrefPubMedGoogle Scholar
• 13 Haas D W, McAndrew M P. Bacterial osteomyelitis in adults: evolving considerations in diagnosis and treatment.  Am J Med. 1996;  101 550-561
  CrossrefPubMedGoogle Scholar
• 14 Kothari N A, Pelchovitz D P, Meyer P J. Imaging of musculoskeletal infections.  Radiol Clin North Am. 2001;  39 653-671
  CrossrefPubMedGoogle Scholar
• 15 Gold R H, Hawkins R A, Katz R D. Bacterial osteomyelitis: findings on plain radiography CT, MR and scintigraphy.  AJR Am J Roentgenol. 1991;  157 365-370
  PubMedGoogle Scholar
• 16 Termaat M F, Raijmakers P G, Scholtein H J et al.. The accuracy of diagnostic imaging for the assessment of chronic osteomyelitis: a systematic review and meta-analysis.  J Bone Joint Surg Am. 2005;  87 2464-2471
  CrossrefPubMedGoogle Scholar
• 17 Bohndorf K. Infection of the appendicular skeleton.  Eur Radiol. 2004;  14(Suppl 3) E53-E63
  PubMedGoogle Scholar
• 18 Cardinal E, Bureau N, Aubin B. Role of the ultrasound in musculoskeletal infections.  Radiol Clin North Am. 2001;  39 191-201
  CrossrefPubMedGoogle Scholar
• 19 Kaiser S, Rosenborg M. Early detection of subperiosteal abscesses by ultrasonography: a means for further successful treatment in pediatric osteomyelitis.  Pediatr Radiol. 1994;  24 336-339
  PubMedGoogle Scholar
• 20 Meyers S P, Wiener S N. Diagnosis of hematogenous pyogenic vertebral osteomyelitis by magnetic resonance imaging.  Arch Intern Med. 1991;  151 683-687
  CrossrefPubMedGoogle Scholar
• 21 Kocher M S, Lee B, Dolan M, Weinberg J, Shulman S T. Pediatric orthopedic infections; early detection and treatment.  Pediatr Ann. 2006;  35 112-122
  PubMedGoogle Scholar
• 22 Jevtic V. Vertebral infection.  Eur Radiol. 2004;  14(Suppl 3) E43-E52
  CrossrefPubMedGoogle Scholar
• 23 Flemming D, Murphey M, McCarthy K. Imaging of the foot and ankle: summary and update.  Curr Opin Orthop. 2005;  16 54-59
  PubMedGoogle Scholar
• 24 Towers J D. The use of intravenous contrast in MRI of extremity infection.  Semin Ultrasound CT MR. 1997;  18 269-275
  CrossrefPubMedGoogle Scholar
• 25 Mahnken A H, Bücker A, Adam G, Günther R W. MRI of osteomyelitis: sensitivity and specificity of STIR sequences in comparison with contrast-enhaned T1 spin echo sequences.  Rofo.. 2000;  172 1016-1019
  Article in Thieme ConnectPubMedGoogle Scholar
• 26 Santiago-Restrepo C, Giménez C R, McCarthy K. Imaging of osteomyelitis and musculoskeletal soft tissue infections: current concepts.  Rheum Dis Clin North Am. 2003;  29 89-109
  CrossrefPubMedGoogle Scholar
• 27 Littenberg B, Mushlin A I. Technetium bone scanning in the diagnosis of osteomyelitis: a meta-analysis of test performance.  J Gen Intern Med. 1992;  7 158-163
  CrossrefPubMedGoogle Scholar
• 28 Schauwecker D S. The scintigraphic diagnosis of osteomyelitis.  AJR Am J Roentgenol. 1992;  158 9-18
  PubMedGoogle Scholar
• 29 Lewin J S, Rosenfield N S, Hoffer P B, Downing D. Acute osteomyelitis in children: combined Tc-99m and Ga-67 imaging.  Radiology. 1986;  158 795-804
  PubMedGoogle Scholar
• 30 Palestro C J, Love C, Miller T T. Imaging of musculoskeletal infections.  Best Pract Res Clin Rheumatol. 2006;  20 1197-1218
  CrossrefPubMedGoogle Scholar
• 31 Becker W, Blair J, Behr T et al.. Detection of soft tissue infections and osteomyelitis using a technetium-99m-labeled anti-granulocyte monoclonal antibody fragment.  J Nucl Med. 1994;  35 1436-1443
  PubMedGoogle Scholar
• 32 Love C, Tronco G, Palestro C. Imaging of infection and inflammation with 99m Tc-fanolesumab.  Q J Nucl Med Mol Imaging. 2006;  50 113-120
  PubMedGoogle Scholar
• 33 Stumpe K D, Strobel K. 18 F FDG-PET imaging in musculoskeletal infection.  Q J Nucl Med Mol Imaging. 2006;  50 131-142
  PubMedGoogle Scholar
• 34 Britton K E, Wareham D W, Das S S et al.. Imaging bacterial infection with 99mTc ciprofloxacin.  J Clin Pathol. 2002;  55 817-823
  CrossrefPubMedGoogle Scholar
• 35 Rubello D, Casara D, Maran A, Avogaro A, Tiengo A, Muzzio P. Role of antigranulocyte FabŽ fragment antibody scintigraphy (Leukoscan) in evaluating bone infection: acquisition protocol, interpretation criteria and clinical results.  Nucl Med Commun. 2004;  25 39-47
  CrossrefPubMedGoogle Scholar

Carlos PinedaM.D. 

Biomedical Research Subdirector, Instituto Nacional de Rehabilitacion, Avenida Mexico-Xochimilco No. 289

Arenal de Guadalupe, Tlalpan, Mexico City 14389, Mexico

Email: carpineda@yahoo.com