Radionuclide investigation of osteomyelitis

The diagnosis of osteomyelitis in the presence of fracture and orthopedic appliances and in the diabetic foot can be a formidable challenge to radionuclide imaging. Radiophosphate is highly sensitive in detecting bone disease, but of low specificity; to improve specificity it must be complemented by 67Ga or radiolabeled leukocytes. These latter agents are not without limitations, and the search for new agents and novel imaging strategies continues. The relative roles of nuclear medicine and MR imaging are coming into focus, and a diagnostic algorithm based on the shortcomings of both methods is suggested.