Imaging in osteomyelitis: Difference between revisions
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= Imaging in osteomyelitis = |
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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. |
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[[Category:Bone and joint infections]] |
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Revision as of 17:33, 13 August 2019
| 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. 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.
