Imaging in osteomyelitis - Revision history

Aidan at 14:12, 6 October 2022

2022-10-06T14:12:29Z

← Older revision		Revision as of 14:12, 6 October 2022
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	==Specific Indications==		==Specific Indications==

	*Post-fixation with hardware: WBC scan likely best, since none of the others can reliably distinguish between post-op changes and infection.		*'''Post-fixation with hardware:''' WBC scan likely best, since none of the others can reliably distinguish between post-op changes and infection.
			*'''Pressure ulcers:''' imaging (including MRI and WBC scan) cannot distinguish infection from bone remodeling due to pressure alone, with specificities decreasing to 15-60% range for all modalities

	==Further Reading==		==Further Reading==

Aidan at 16:31, 26 August 2020

2020-08-26T16:31:05Z

← Older revision		Revision as of 16:31, 26 August 2020
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	{\| class="wikitable"		{\| class="wikitable"
	! Technique		!Technique
	! Advantages		!Advantages
	! Disadvantages		!Disadvantages
	! Sn~~/Sp~~		!Sn
			!Sp
	! Main Findings		!Main Findings
	\|-		\|-
	\| X-ray		\|X-ray
	\| Inexpensive, reproducible, and accessible		\|Inexpensive, reproducible, and accessible
	\| Late diagnosis, confusing, and radiation		\|Late diagnosis, confusing, and radiation
	\| 43 to 75~~%/75 to 83~~%		\|43 to 75%
			\|75 to 83%
	\| Lytic lesions, osteopenia, periosteal thickening, loss of trabecular architecture, new bone apposition		\|Lytic lesions, osteopenia, periosteal thickening, loss of trabecular architecture, new bone apposition
	\|-		\|-
	\| CT		\|CT
	\| Excellent spatial resolution		\|Excellent spatial resolution
	\| Cost, availability, radiation exposure		\|Cost, availability, radiation exposure
	\| 67%~~/50% (chronic)~~		\|67%
			\|50%
	\| Blurring of fat planes, increased density of fatty marrow, periosteal reaction, cortical erosion or destruction, and sequestra, involucra, and intraosseous gas		\|Blurring of fat planes, increased density of fatty marrow, periosteal reaction, cortical erosion or destruction, and sequestra, involucra, and intraosseous gas
	\|-		\|-
	\| US		\|US
	\| Accessibility, inexpensive, real-time evaluation, guided aspiration/biopsy		\|Accessibility, inexpensive, real-time evaluation, guided aspiration/biopsy
	\| Operator dependent, cannot image across cortical bone		\|Operator dependent, cannot image across cortical bone
	\| To be determined		\| colspan="2" \|To be determined
	\| Elevated periosteum, soft tissue abscesses and fluid collections		\|Elevated periosteum, soft tissue abscesses and fluid collections
	\|-		\|-
	\| MRI		\|MRI
	\| Excellent spatial resolution, early detection, assesses extent of tissues affected		\|Excellent spatial resolution, early detection, assesses extent of tissues affected
	\| Cost, availability, time requested		\|Cost, availability, time requested
	\| 82 to 100~~%/75 to 96~~%		\|82 to 100%
			\|75 to 96%
	\| Acute: T1 shows low-signal-intensity medullary space; T2 shows high intensity surronuding inflammatory processes and edema; Gad enhances areas of necrosis<br/>Subacute: evidence of Brodie's abscess, single or multiple radiolucent abscesses; T1 shows central abscess cavity with low intensity; T2 shows high intensity of granulation tissue surrounded by low-intensity band of bone sclerosis (double-line)<br/>Chronic: T1 and T2 show low-intensity areas of devascularized fibrotic scarring in the marrow		\|Acute: T1 shows low-signal-intensity medullary space; T2 shows high intensity surronuding inflammatory processes and edema; Gad enhances areas of necrosis<br />Subacute: evidence of Brodie's abscess, single or multiple radiolucent abscesses; T1 shows central abscess cavity with low intensity; T2 shows high intensity of granulation tissue surrounded by low-intensity band of bone sclerosis (double-line)<br />Chronic: T1 and T2 show low-intensity areas of devascularized fibrotic scarring in the marrow
	\|-		\|-
	\| Bone scan		\|Bone scan
	\| Sensitive, available, relatively cheap, early detection		\|Sensitive, available, relatively cheap, early detection
	\| Nonspecific, further imaging required		\|Nonspecific, further imaging required
	\| ~85~~%/~25~~%		\|~85%
			\|~25%
	\| Focal hyperperfusion or hyperemia or bone uptake		\|Focal hyperperfusion or hyperemia or bone uptake
	\|-		\|-
	\| Bone+WBC scan		\|Bone+WBC scan
	\| Reliable when clearly positive or negative		\|Reliable when clearly positive or negative
	\| Need for two isotopes with multiple imaging sessions over several days, higher radiation exposure, often equivocal results, long examination time (days)		\|Need for two isotopes with multiple imaging sessions over several days, higher radiation exposure, often equivocal results, long examination time (days)
	\| ~60~~%/~80~~%		\|~60%
			\|~80%
	\| Localized area of increased uptake		\|Localized area of increased uptake
	\|}		\|}

	== Specific Indications ==		==Specific Indications==

	* Post-fixation with hardware: WBC scan likely best, since none of the others can reliably distinguish between post-op changes and infection.		*Post-fixation with hardware: WBC scan likely best, since none of the others can reliably distinguish between post-op changes and infection.

	== Further Reading ==		==Further Reading==

	* Pineda C, Espinosa R, Pena A. [https://doi.org/10.1055/s-0029-1214160 Radiographic Imaging in Osteomyelitis: The Role of Plain Radiography, Computed Tomography, Ultrasonography, Magnetic Resonance Imaging, and Scintigraphy]. ''Semin Plast Surg''. 2009;23(2):080-089.		*Pineda C, Espinosa R, Pena A. [https://doi.org/10.1055/s-0029-1214160 Radiographic Imaging in Osteomyelitis: The Role of Plain Radiography, Computed Tomography, Ultrasonography, Magnetic Resonance Imaging, and Scintigraphy]. ''Semin Plast Surg''. 2009;23(2):080-089.
	* [https://doi.org/10.1097/00006231-200608000-00006 Nuclear medicine imaging of bone infections]. ''Nuc Med Comm''. 2006;27:633–644.		*[https://doi.org/10.1097/00006231-200608000-00006 Nuclear medicine imaging of bone infections]. ''Nuc Med Comm''. 2006;27:633–644.

	[[Category:Bone and joint infections]]		[[Category:Bone and joint infections]]

Aidan at 15:15, 2 September 2019

2019-09-02T15:15:46Z

← Older revision		Revision as of 15:15, 2 September 2019
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	\| Localized area of increased uptake		\| Localized area of increased uptake
	\|}		\|}

			== Specific Indications ==

			* Post-fixation with hardware: WBC scan likely best, since none of the others can reliably distinguish between post-op changes and infection.

	== Further Reading ==		== Further Reading ==

Aidan: /* Further Reading */

2019-09-02T14:55:06Z

Aidan: Added more references and updated table format

2019-09-02T14:51:51Z

Added more references and updated table format

Show changes

Aidan at 14:37, 2 September 2019

2019-09-02T14:37:51Z

← Older revision		Revision as of 14:37, 2 September 2019
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			{\| class="wikitable"
	{\|
	! Technique		! Technique
	! Advantages		! Advantages

Aidan: Aidan moved page Bone and joint Imaging in osteomyelitis to Imaging in osteomyelitis without leaving a redirect

2019-08-13T17:33:25Z

Aidan moved page Bone and joint Imaging in osteomyelitis to Imaging in osteomyelitis without leaving a redirect

← Older revision	Revision as of 17:33, 13 August 2019
(No difference)

Aidan at 17:33, 13 August 2019

2019-08-13T17:33:17Z

← Older revision		Revision as of 17:33, 13 August 2019
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	= Imaging in osteomyelitis =

	{\|		{\|
	! Technique		! Technique
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	* Pineda C, Espinosa R, Pena A. [[10.1055/s-0029-1214160\|Radiographic Imaging in Osteomyelitis: The Role of Plain Radiography, Computed Tomography, Ultrasonography, Magnetic Resonance Imaging, and Scintigraphy]]. ''Semin Plast Surg''. 2009;23(2):080-089.		* Pineda C, Espinosa R, Pena A. [[10.1055/s-0029-1214160\|Radiographic Imaging in Osteomyelitis: The Role of Plain Radiography, Computed Tomography, Ultrasonography, Magnetic Resonance Imaging, and Scintigraphy]]. ''Semin Plast Surg''. 2009;23(2):080-089.


			[[Category:Bone and joint infections]]

Maintenance script: Imported from text file

2019-08-11T18:05:48Z

Imported from text file

New page

= Imaging in osteomyelitis =

{|
! Technique
! Advantages
! Disadvantages
! Sn/Sp
! Main Findings
|-
| X-ray
| Inexpensive
| Late diagnosis
| 43 to 75%/75 to 83%
| Lytic lesions, osteopenia, periosteal thickening, loss of trabecular architecture, new bone apposition
|-
|
| Reproducible
| Confusing
|
|
|-
|
| Accessible
| Radiation
|
|
|-
| CT
| Excellent spatial resolution
| Cost
| 67%/50% (chronic)
| Blurring of fat planes
|-
|
|
| Availability
|
| Increased density of fatty marrow
|-
|
|
| Radiation exposure
|
| Periosteal reaction
|-
|
|
|
|
| Cortical erosion or destruction
|-
|
|
|
|
| Sequestra, involucra, intraosseous gas
|-
| US
| Accessibility, inexpensive, real-time evaluation
| Operator dependent
| To be determined
| Elevated periosteum
|-
|
| Guided aspiration-biopsy
| US beam cannot cross cortical bone
|
| Soft tissue abscess
|-
|
|
|
|
| Fluid collection
|-
| MRI
| Excellent spatial resolution
| Cost
| 82 to 100%/75 to 96%
| Acute
|-
|
| Early detection
| Availability
|
| T1-weighted: low-signal-intensity medullary space
|-
|
| Assessment of the extent of tissue affected
| Time requested
|
| T2-weighted: high signal intensity surrounding inflammatory processes, edema
|-
|
|
|
|
| Gadolinium: enhances areas of necrosis
|-
|
|
|
|
| Subacute
|-
|
|
|
|
| Evidence of Brodie's abscess, single or multiple radiolucent abscesses
|-
|
|
|
|
| T1-weighted: central abscess cavity with low signal intensity
|-
|
|
|
|
| T2-weighted: high signal intensity of granulation tissue surrounded by low-signal-intensity band of bone sclerosis (double-line effect)
|-
|
|
|
|
| Chronic
|-
|
|
|
|
| T1- and T2-weighted: low-signal-intensity areas of devascularized fibrotic scarring in the marrow
|-
| Bone scan
| Sensitive
| Nonspecific
| ~85%/~25%
| Focal hyperperfusion
|-
|
| Availability
| Further imaging evaluation required
|
| Focal hyperemia
|-
|
| Relatively inexpensive
|
|
| Focal bone uptake
|-
|
| Early detection
|
|
|
|-
| Bone+WBC scan
| Reliable when clearly positive or negative
| Need for two isotopes with multiple imaging sessions over several days
| ~60%/~80%
| Localized area of increased uptake
|-
|
|
| High radiation exposure
|
|
|-
|
|
| Large number of equivocal results
|
|
|-
|
|
| Long examination time
|
|
|}

== Further Reading ==

* Pineda C, Espinosa R, Pena A. [[10.1055/s-0029-1214160|Radiographic Imaging in Osteomyelitis: The Role of Plain Radiography, Computed Tomography, Ultrasonography, Magnetic Resonance Imaging, and Scintigraphy]]. ''Semin Plast Surg''. 2009;23(2):080-089.

← Older revision		Revision as of 14:55, 2 September 2019
Line 46:		Line 46:

	* Pineda C, Espinosa R, Pena A. [https://doi.org/10.1055/s-0029-1214160 Radiographic Imaging in Osteomyelitis: The Role of Plain Radiography, Computed Tomography, Ultrasonography, Magnetic Resonance Imaging, and Scintigraphy]. ''Semin Plast Surg''. 2009;23(2):080-089.		* Pineda C, Espinosa R, Pena A. [https://doi.org/10.1055/s-0029-1214160 Radiographic Imaging in Osteomyelitis: The Role of Plain Radiography, Computed Tomography, Ultrasonography, Magnetic Resonance Imaging, and Scintigraphy]. ''Semin Plast Surg''. 2009;23(2):080-089.
	* [https://doi.org/10.1097/00006231-200608000-00006 Nuclear medicine imaging of bone infections]. ''Nuc Med Comm''. 2006(27):633–644.		* [https://doi.org/10.1097/00006231-200608000-00006 Nuclear medicine imaging of bone infections]. ''Nuc Med Comm''. 2006;27:633–644.

	[[Category:Bone and joint infections]]		[[Category:Bone and joint infections]]