Pitfalls in osteoarticular imaging: how to distinguish bone infection from tumour?

Area of Science:

• Medical Imaging
• Radiology
• Oncology

Background:

• Osteoarticular imaging plays a vital role in diagnosing bone pathologies.
• Distinguishing between infectious (osteomyelitis) and neoplastic (bone tumors) processes can be challenging.
• Accurate differentiation is essential for appropriate patient management and treatment.

Purpose of the Study:

• To elucidate the differential diagnostic features between osteomyelitis and bone tumors in osteoarticular imaging.
• To highlight common pitfalls in the radiological interpretation of these conditions.
• To provide a guide for radiologists and clinicians in differentiating these entities.

Main Methods:

• Review of radiological features of osteomyelitis and bone tumors.
• Comparative analysis of imaging findings across conventional radiology, computed tomography (CT), and magnetic resonance imaging (MRI).
• Identification of specific imaging characteristics that favor one diagnosis over the other.

Main Results:

• Osteomyelitis typically presents with periosteal reaction, sequestrum, and involucrum, often with associated soft tissue inflammation.
• Bone tumors may exhibit cortical destruction, periosteal new bone formation (e.g., Codman's triangle, sunburst pattern), and matrix mineralization.
• CT and MRI provide complementary information, with MRI offering superior soft tissue contrast and lesion characterization.

Conclusions:

• Radiological assessment requires careful evaluation of specific imaging features to differentiate osteomyelitis from bone tumors.
• Understanding the nuances of CT and MRI findings is critical to avoid diagnostic errors.
• This review aims to improve diagnostic accuracy in challenging osteoarticular imaging cases.