Radionuclide imaging in osteomyelitis

The utility of bone imaging has remained significantly high despite the proven suboptimal specificity of the conventional three-phase bone scan. The quantitative four-phase study may play a role in maintaining its usefulness in the future. However, due to its extremely high sensitivity and excellent anatomical information, it remains as the first diagnostic study in most suspected cases of acute osteomyelitis. The future would see development of new imaging modalities aimed at enhancing the specificity for diagnosis of active osteomyelitis. The indium leucocyte study has been the single most important development in this respect in the last decade. NMR has been another important addition to complement the anatomical information for defining the extent and nature of infectious process--acute or chronic. It remains to be seen if the other investigative work on antigranulocyte antibodies or other imaging agents or techniques would make the future diagnosis of osteomyelitis more reliable and accurate using the nuclear medicine techniques.