Imaging of Osteomyelitis in the Mature Skeleton
Section snippets
Conventional Radiography
In the early stage of osteomyelitis, the findings on conventional radiography may be normal for 10 to 21 days after the onset of infection because a 30% to 50% loss of bone density must occur before a radiograph becomes abnormal.7, 69 In osteomyelitis, the earliest radiographic finding is deep soft tissue swelling that may cause obliteration of the tissue planes. Localized osteoporosis and bone resorption caused by infection in the medullary space with hyperemia, edema or abscess formation, and
SUBACUTE AND CHRONIC OSTEOMYELITIS
Subacute osteomyelitis may occur in abnormal bone or after inadequate antibiotic therapy. This commonly appears as a well-defined osteolytic metaphyseal lesion. This discrete Brodie's abscess (Figs. 14 and 15) has a sclerotic margin that fades peripherally and creates a fuzzy sclerotic margin. Occasionally, the Brodie's abscess appears as a serpiginous lucency (Fig. 15) in the metaphysis of the long bones. These features are often pathognomonic on plain radiographs. Lower extremity involvement
CHRONIC RECURRENT MULTIFOCAL OSTEOMYELITIS
This rare form of osteomyelitis of unknown cause predominantly affects children and young adults between the ages of 19 months and 27 years. The multifocal metaphyseal lesions are often, but not invariably, symmetric and often exhibit bouts of exacerbation and remission. The tibia is most frequently involved, followed by the femur, clavicle, and fibula. Other sites include the short bones of the hands and feet, sternum, and axial skeletal.15 The erythrocyte sedimentation rate is elevated in
DIABETIC FOOT OSTEOMYELITIS
Early diagnosis of osteomyelitis in patients with diabetes is particularly important in preventing progression of the disease and prompt treatment has been noted to decrease the rate of amputation in this patient population.3, 19 Plain films (Figs. 2, 23 and 24) have a lower sensitivity than other methods, but a specificity that is comparable with bone scan. False-positive radiographs are often associated with neuropathic joints or degenerative or inflammatory arthritis.14, 57 Neuropathic
VERTEBRAL OSTEOMYELITIS
Vertebral osteomyelitis is the most common form of hematogenously acquired osteomyelitis in adults. Spinal infection is discussed elsewhere in this issue.
CRANIAL OSTEOMYELITIS
Cranial osteomyelitis (Fig. 29) arises from complications of paranasal sinus infection, trauma, dental extractions, chronic periodontal disease, chronic mastoiditis, necrotizing otitis externa, and various surgeries. Imaging diagnosis of osteomyelitis is difficult when there is concurrent bone destruction or repair because of a nonifectious process. In a study involving 25 cases evaluating the diagnosis of cranial osteomyelitis using different modalities, including111In-WBC and 99mTC-MDP bone
PRESENCE OF HEMOGLOBINOPATHY
Vaso-occlusive crisis with infarction of bone marrow or cortex is typically characterized by pain of various severity and duration at one or more sites. In some instances, swelling, erythema, fever, and leukocytosis develop, raising the possibility of osteomyelitis. It must be mentioned that the serious consideration of infection, prompted by moderate or marked fever and localized signs of inflammation, occurs in only 10% to 15% of patients who come to the emergency room for visits for sickle
SUMMARY
Diagnosis of acute osteomyelitis is often challenging but can be made by plain radiograph, bone scan, or MR imaging. This diagnosis may be more problematic in small bones, in diabetic or immunocompromised patients, those partially treated, post-traumatic, previous surgery, or with pre-existing marrow conditions and associated soft tissue infections. CT is the modality of choice for revealing sequestra and cortical erosions in chronic osteomyelitis. Nonenhanced and enhanced STIR or fat-saturated
References (71)
- et al.
Osteomyelitis in the feet of diabetic patients: Long-term results, prognostic factors, and the role of antimicrobial and surgical therapy
Am J Med
(1987) - et al.
Magnetic resonance imaging: Application in musculoskeletal infection
Magn Reson Imaging
(1985) - et al.
The radiology of osteomyelitis
Orthop Clin North Am
(1983) - et al.
Update on imaging of orthopedic infections
Orthop Clin North Am
(1998) - et al.
Magnetic resonance differentiation of acute and chronic osteomyelitis in children
Clin Radiol
(1990) - et al.
Detection of acute inflammation with 111In-labeled nonspecific polyclonal IgG
Semin Nucl Med
(1988) - et al.
99m Tc-nanocolloid scintigraphy for assessing osteomyelitis in diabetic neuropathic feet
Clin Radiol
(1998) - et al.
Imaging osteomyelitis
Arthritis Rheum
(1994) - et al.
Osteomyelitis and infarction in sickle cell hemoglobinopathies: Differentiation by combined technetium and gallium scintigraphy
Radiology
(1984) - et al.
Rapid imaging of infections with a monoclonal antibody gragment (LeukoScan)
Clin Orthop
(1996)
The diabetic foot: Magnetic resonance imaging evaluation
Skeletal Radiol
Gadolinium-DOTA enhanced MRI of painful osseous crisis in children and sickle cell anemia
Pediatr Radiol
The SAPHO syndrome: An evolving concept for unifying several idiopathic disorders of bone and skin
AJR Am J Roentgenol
Osteomyelitis in the diabetic foot: MRI vs indium scan, prospective double blind study with pathologic correlation [abstract]
AJR Am J Roentgenol
Osteomyelitis of diabetic foot
MR imaging-pathologic correlation
Imaging evaluation of osteomyelitis
Crit Rev Diagn Imaging
Chronic recurrent multifocal osteomyelitis
Skeletal Radiol
Multimodality imaging of osteomyelitis
Eur J Nucl Med
Osteomyelitis: Characteristics and pitfalls of diagnosis with MR imaging
Radiology
Imaging the diabetic foot
Skeletal Radiol
Intraindividual comparison of 99m Tc-labelled anti-SSEA-1 antigranulocyte antibody and 99m Tc-HMPAO labelled white blood cells for the imaging of infection
Eur J Nucl Med
Chronic osteomyelitis: Detection with FDG PET and correlation with histopathologic findings
Radiology
Fluorine-18-FDG PET and technetium-99m antigranulocyte antibody scintigraphy in chronic osteomyelitis
J Nucl Med
Acute hematogenous pelvic osteomyelitis in athletes
Am J Sports Med
Gadolinium-DTPA-enhanced magnetic resonance imaging of musculoskeletal infectious process
Skeletal Radiol
Fine-needle bone biopsy to diagnose osteomyelitis
J Bone Joint Surg Br
Diagnosis of osteomyelitis in the presence of soft-tissue infection and radiologic evidence of osseous abnormalities: Value of leukocyte scintigraphy
AJR Am J Roentgenol
Prospective study of bone, indium-111-labeled white blood cell, and gallium-67 scanning for the evaluation of osteomyelitis in the diabetic foot
Foot Ankle Int
Combined bone marrow and gallium imaging: Differentiation of osteomyelitis and infarction in sickle hemoglobinopathy
Clin Nucl Med
Chronic complicated osteomyelitis of the appendicular skeleton: Diagnosis with technetium-99m labeled monoclonal antigranulocyte antibody-immunoscintigraphy
Eur J Nucl Med
Fast diagnosis of abdominal infections and inflammations with technetium-99m-HMPAO labeled leukocytes
J Nucl Med
Osteomyelitis
N Engl J Med
Detection of osteomyelitis in the neuropathic foot: Nuclear medicine, MRI, and conventional medicine
Clin Nucl Med
Osteomyelitis of the foot in diabetic patients
Clin Infect Dis
Diagnostic value of sinus-tract cultures in chronic osteomyelitis
JAMA
Cited by (0)
Address reprint requests to Jamshid Tehranzadeh, MD, Department of Radiological Sciences (R-140), University of California, Irvine Medical Center, 101 The City Drive, Orange, CA 92868ā3298, e-mail: [email protected]