Imaging of osteomyelitis with special reference to children

Infection of bone in children represents a diagnostic and therapeutic challenge to the pediatrician, the surgeon, the radiologist, and the pathologist. The pattern of manifestation varies and is dependent on the site of involvement, the initiating event, the infecting organism, and the acute or chronic nature of the illness. Early diagnosis allows prompt treatment, which can prevent many of the dreaded complications of this disease. Plain radiographs remain the initial imaging modality used in the diagnosis and differential diagnosis of osteomyelitis. However, with the advent of newer imaging techniques such as scintigraphy, ultrasonography, computed tomography, and magnetic resonance imaging, a higher degree of accuracy in diagnosis and definition of the extent of the disease has been achieved. The time interval between the onset of symptoms and diagnosis has also been significantly reduced. Although magnetic resonance imaging has the additional advantage of multiplanar capability, greater anatomic detail, and excellent soft tissue resolution, it is a relatively expensive technique, which somewhat limits its use. Following a brief review of the classification and pathophysiology of osteomyelitis, we have tried to elucidate the utility of various imaging modalities in the diagnosis of osteomyelitis in children, outlining their relative strengths and weaknesses. Certain entities specific to children and a brief review of differential diagnosis are also presented.