Imaging in osteomyelitis: Difference between revisions
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| X-ray |
| X-ray |
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| Inexpensive |
| Inexpensive, reproducible, and accessible |
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| Late diagnosis |
| Late diagnosis, confusing, and radiation |
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| 43 to 75%/75 to 83% |
| 43 to 75%/75 to 83% |
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| Lytic lesions, osteopenia, periosteal thickening, loss of trabecular architecture, new bone apposition |
| Lytic lesions, osteopenia, periosteal thickening, loss of trabecular architecture, new bone apposition |
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| Reproducible |
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| Confusing |
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| Accessible |
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| Radiation |
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| CT |
| CT |
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| Excellent spatial resolution |
| Excellent spatial resolution |
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| Cost, availability, radiation exposure |
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| Cost |
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| 67%/50% (chronic) |
| 67%/50% (chronic) |
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| Blurring of fat planes, increased density of fatty marrow, periosteal reaction, cortical erosion or destruction, and sequestra, involucra, and intraosseous gas |
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| Blurring of fat planes |
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| Availability |
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| Increased density of fatty marrow |
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| Radiation exposure |
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| Periosteal reaction |
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| Cortical erosion or destruction |
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| Sequestra, involucra, intraosseous gas |
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| US |
| US |
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| Accessibility, inexpensive, real-time evaluation |
| Accessibility, inexpensive, real-time evaluation, guided aspiration/biopsy |
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| Operator dependent |
| Operator dependent, cannot image across cortical bone |
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| To be determined |
| To be determined |
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| Elevated periosteum |
| Elevated periosteum, soft tissue abscesses and fluid collections |
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| Guided aspiration-biopsy |
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| US beam cannot cross cortical bone |
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| Soft tissue abscess |
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| Fluid collection |
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| MRI |
| MRI |
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| Excellent spatial resolution |
| Excellent spatial resolution, early detection, assesses extent of tissues affected |
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| Cost, availability, time requested |
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| Cost |
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| 82 to 100%/75 to 96% |
| 82 to 100%/75 to 96% |
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| 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 |
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| Acute |
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| Early detection |
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| Availability |
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| T1-weighted: low-signal-intensity medullary space |
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| Assessment of the extent of tissue affected |
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| Time requested |
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| T2-weighted: high signal intensity surrounding inflammatory processes, edema |
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| Gadolinium: enhances areas of necrosis |
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| Subacute |
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| Evidence of Brodie's abscess, single or multiple radiolucent abscesses |
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| T1-weighted: central abscess cavity with low signal intensity |
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| T2-weighted: high signal intensity of granulation tissue surrounded by low-signal-intensity band of bone sclerosis (double-line effect) |
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| Chronic |
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| T1- and T2-weighted: low-signal-intensity areas of devascularized fibrotic scarring in the marrow |
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| Bone scan |
| Bone scan |
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| Sensitive, available, relatively cheap, early detection |
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| Sensitive |
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| Nonspecific |
| Nonspecific, further imaging required |
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| ~85%/~25% |
| ~85%/~25% |
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| Focal hyperperfusion |
| Focal hyperperfusion or hyperemia or bone uptake |
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| Availability |
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| Further imaging evaluation required |
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| Focal hyperemia |
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| Relatively inexpensive |
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| Focal bone uptake |
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| Early detection |
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| Bone+WBC scan |
| Bone+WBC scan |
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| Reliable when clearly positive or negative |
| Reliable when clearly positive or negative |
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| 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) |
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| ~60%/~80% |
| ~60%/~80% |
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| Localized area of increased uptake |
| Localized area of increased uptake |
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| High radiation exposure |
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| Large number of equivocal results |
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| Long examination time |
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== Further Reading == |
== Further Reading == |
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* 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. |
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* [https://doi.org/10.1097/00006231-200608000-00006 Nuclear medicine imaging of bone infections]. ''Nuc Med Comm''. 2006(27):633–644. |
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[[Category:Bone and joint infections]] |
[[Category:Bone and joint infections]] |
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Revision as of 14:51, 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.
