Bacterial osteomyelitis: findings on plain radiography, CT, MR, and scintigraphy

Early detection of osteomyelitis is essential if appropriate therapy is to be started before bone devitalization. Although the 99mTc-methylene diphosphonate (MDP) bone scan may signify the possibility of osteomyelitis days or weeks before osseous changes are apparent on standard radiographs, the radiographic changes may provide important diagnostic clues. The 67Ga-citrate scan augments the diagnostic value of the 99mTc-MDP scan, and the 111In-labeled WBC scan is useful for detecting abscesses. CT aids in the detection of sequestra, and MR imaging is useful in defining the extent of the inflammatory process and in distinguishing osteomyelitis from cellulitis. In this article, we review and correlate the changes of bacterial osteomyelitis shown by these imaging methods.