Imaging in osteomyelitis: Difference between revisions
From IDWiki
mNo edit summary |
(Added more references and updated table format) |
||
Line 7: | Line 7: | ||
|- |
|- |
||
| X-ray |
| X-ray |
||
− | | Inexpensive |
+ | | Inexpensive, reproducible, and accessible |
− | | Late diagnosis |
+ | | 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 |
||
− | |- |
||
− | | |
||
− | | Reproducible |
||
− | | Confusing |
||
− | | |
||
− | | |
||
− | |- |
||
− | | |
||
− | | Accessible |
||
− | | Radiation |
||
− | | |
||
− | | |
||
|- |
|- |
||
| CT |
| CT |
||
| Excellent spatial resolution |
| Excellent spatial resolution |
||
+ | | Cost, availability, radiation exposure |
||
− | | Cost |
||
| 67%/50% (chronic) |
| 67%/50% (chronic) |
||
+ | | 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 |
||
− | |- |
||
− | | |
||
− | | |
||
− | | Availability |
||
− | | |
||
− | | Increased density of fatty marrow |
||
− | |- |
||
− | | |
||
− | | |
||
− | | Radiation exposure |
||
− | | |
||
− | | Periosteal reaction |
||
− | |- |
||
− | | |
||
− | | |
||
− | | |
||
− | | |
||
− | | Cortical erosion or destruction |
||
− | |- |
||
− | | |
||
− | | |
||
− | | |
||
− | | |
||
− | | Sequestra, involucra, intraosseous gas |
||
|- |
|- |
||
| US |
| US |
||
− | | Accessibility, inexpensive, real-time evaluation |
+ | | Accessibility, inexpensive, real-time evaluation, guided aspiration/biopsy |
− | | Operator dependent |
+ | | Operator dependent, cannot image across cortical bone |
| To be determined |
| To be determined |
||
− | | Elevated periosteum |
+ | | Elevated periosteum, soft tissue abscesses and fluid collections |
− | |- |
||
− | | |
||
− | | Guided aspiration-biopsy |
||
− | | US beam cannot cross cortical bone |
||
− | | |
||
− | | Soft tissue abscess |
||
− | |- |
||
− | | |
||
− | | |
||
− | | |
||
− | | |
||
− | | Fluid collection |
||
|- |
|- |
||
| MRI |
| MRI |
||
− | | Excellent spatial resolution |
+ | | Excellent spatial resolution, early detection, assesses extent of tissues affected |
+ | | Cost, availability, time requested |
||
− | | Cost |
||
| 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 |
||
− | |- |
||
− | | |
||
− | | 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 |
| Bone scan |
||
+ | | Sensitive, available, relatively cheap, early detection |
||
− | | Sensitive |
||
− | | Nonspecific |
+ | | Nonspecific, further imaging required |
| ~85%/~25% |
| ~85%/~25% |
||
− | | Focal hyperperfusion |
+ | | Focal hyperperfusion or hyperemia or bone uptake |
− | |- |
||
− | | |
||
− | | Availability |
||
− | | Further imaging evaluation required |
||
− | | |
||
− | | Focal hyperemia |
||
− | |- |
||
− | | |
||
− | | Relatively inexpensive |
||
− | | |
||
− | | |
||
− | | Focal bone uptake |
||
− | |- |
||
− | | |
||
− | | Early detection |
||
− | | |
||
− | | |
||
− | | |
||
|- |
|- |
||
| 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 |
+ | | 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 |
||
− | |- |
||
− | | |
||
− | | |
||
− | | High radiation exposure |
||
− | | |
||
− | | |
||
− | |- |
||
− | | |
||
− | | |
||
− | | Large number of equivocal results |
||
− | | |
||
− | | |
||
− | |- |
||
− | | |
||
− | | |
||
− | | Long examination time |
||
− | | |
||
− | | |
||
|} |
|} |
||
== Further Reading == |
== Further Reading == |
||
− | * Pineda C, Espinosa R, Pena A. [ |
+ | * 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. |
||
− | |||
[[Category:Bone and joint infections]] |
[[Category:Bone and joint infections]] |
Revision as of 10:51, 2 September 2019
Technique | Advantages | Disadvantages | Sn/Sp | Main Findings |
---|---|---|---|---|
X-ray | Inexpensive, reproducible, and accessible | Late diagnosis, confusing, and radiation | 43 to 75%/75 to 83% | Lytic lesions, osteopenia, periosteal thickening, loss of trabecular architecture, new bone apposition |
CT | Excellent spatial resolution | Cost, availability, radiation exposure | 67%/50% (chronic) | Blurring of fat planes, increased density of fatty marrow, periosteal reaction, cortical erosion or destruction, and sequestra, involucra, and intraosseous gas |
US | Accessibility, inexpensive, real-time evaluation, guided aspiration/biopsy | Operator dependent, cannot image across cortical bone | To be determined | Elevated periosteum, soft tissue abscesses and fluid collections |
MRI | Excellent spatial resolution, early detection, assesses extent of tissues affected | Cost, availability, time requested | 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 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) Chronic: T1 and T2 show low-intensity areas of devascularized fibrotic scarring in the marrow |
Bone scan | Sensitive, available, relatively cheap, early detection | Nonspecific, further imaging required | ~85%/~25% | Focal hyperperfusion or hyperemia or bone uptake |
Bone+WBC scan | 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) | ~60%/~80% | Localized area of increased uptake |
Further Reading
- Pineda C, Espinosa R, Pena A. 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.
- Nuclear medicine imaging of bone infections. Nuc Med Comm. 2006(27):633–644.