Type:
Educational Exhibit
Keywords:
Infection, Education, Diagnostic procedure, PET-CT, Nuclear medicine conventional, MR, Nuclear medicine, Musculoskeletal bone
Authors:
S. Barreto 1, M. McGrath2, M. Mohammed2; 1Syracuse, NY/US, 2SYRACUSE/US
DOI:
10.26044/ecr2019/C-3331
Conclusion
Understanding this complex disease process and identifying specific findings,
which can aid in differentiating OM from other bone lesions is invaluable to the practicing radiologist.
A subperiosteal abscess is often mistaken for a bone tumor in the pediatric population,
the presence of intracellular bone marrow fat within the lesion helps to distinguish this entity as an infectious process.
Knowledge of expanding imaging modalities allow for better consultation with ordering physicians.
While plain radiographs remain the first line study,
even subtle findings can take weeks to become apparent and still underestimate extent of disease.
MRI is the preferred modality,
which can become positive very early on in the disease process with changes in the bone marrow reflected on T1WI and STIR images.
When MRI is contraindicated due prosthesis,
contrast allergy or poor renal function; nuclear medicine can be helpful.
The highly sensitive triple phase bone scan remains the nuclear medicine imaging modality of choice for uncomplicated osteomyelitis.
A negative study can help rule out osteomyelitis.
This study can become positive in the first few days of infection.
The non-specificity of the study is a limiting factor.
Nuclear medicine imaging is avoided in the pediatric population.
Additional WBC-tagged and gallium studies can supplement triple phase bone scans or stand alone in particular settings of prosthesis and spinal infections respectively.
From the ongoing research in the field of nuclear medicine to provide faster,
more reliable and specific imaging; FDG-PET has taken the lead in providing diagnoses in the more challenging areas such as in spinal,
diabetic foot,
and joint prosthesis infections.