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Updated: Mar 7, 2026

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Imaging in osteomyelitis in the growing skeleton.

Birgit Zieger1, H Elser2, J Tröger1

  • 1Abteilung Pädiatrische Radiologie, Radiologische Klinik, Klinikum der Ruprecht-Karls-Universität Heidelberg, Germany.

Der Orthopade
|March 2, 2017
PubMed
Summary

Rapid diagnosis of childhood osteomyelitis is crucial. Imaging, including radiography, sonography, MRI, and bone scans, guides prompt antibiotic therapy to prevent long-term complications.

Keywords:
Key words Osteomyelitis • Radiography • Sonography • Radionuclide imaging • MRI

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Area of Science:

  • Pediatric Radiology
  • Musculoskeletal Imaging
  • Infectious Disease Imaging

Background:

  • Acute osteomyelitis in children requires prompt diagnosis and antibiotic treatment to avoid sequelae.
  • Diagnostic imaging is essential for timely and accurate identification of pediatric osteomyelitis.

Purpose of the Study:

  • To outline an imaging-based diagnostic workup for suspected acute osteomyelitis in children.
  • To detail the roles and advantages of various imaging modalities in diagnosing pediatric osteomyelitis.

Main Methods:

  • Conventional radiography to exclude other diagnoses.
  • Sonography to detect subperiosteal abscesses or joint effusions.
  • MRI or 99mTc-MDP bone scan for unclear cases, based on clinical localization and lesion site.
  • Consideration of labeled white blood cell scintigraphy; avoidance of 67Ga scans due to radiation.

Main Results:

  • Radiography is the initial step, followed by sonography.
  • MRI offers superior anatomical detail, especially for spinal osteomyelitis.
  • Bone scan is valuable for whole-body assessment and multifocal or unlocalized disease.
  • Labeled white blood cell scans are rarely indicated.

Conclusions:

  • A structured imaging approach is vital for diagnosing pediatric osteomyelitis.
  • The choice between MRI and bone scan depends on clinical context and suspected disease extent.
  • Effective imaging strategies facilitate early intervention and improve patient outcomes.