Should single-phase radionuclide bone imaging be used in suspected osteomyelitis?

Area of Science:

• Nuclear Medicine
• Radiology
• Infectious Disease

Background:

• Osteomyelitis diagnosis often relies on imaging.
• Radionuclide bone imaging is a common diagnostic tool.

Purpose of the Study:

• To evaluate the diagnostic and therapeutic impact of delayed, static radionuclide bone imaging for suspected osteomyelitis.
• To assess the accuracy of imaging interpretations.

Main Methods:

• Retrospective review of 69 patients with 86 delayed, static radionuclide bone images.
• Analysis of imaging sensitivity, specificity, and predictive values.
• Evaluation of treatment changes based on imaging results.

Main Results:

• Lower sensitivity, specificity, and positive predictive value compared to other studies.
• Imaging rarely altered treatment when osteomyelitis was unlikely.
• In cases where osteomyelitis was more likely, imaging potentially changed therapy in 19/46 cases but was misleading in 15.
• One-third of interpretations were equivocal and incorrect four times more often than definite readings.
• False positives led to unnecessary surgeries; a false negative resulted in a delayed diagnosis and death.

Conclusions:

• Static-phase radionuclide bone imaging with definite interpretations can be specific, especially when negative.
• "Equivocal" interpretations are associated with significant diagnostic and therapeutic errors.
• Imaging is of limited value and rarely changes management when osteomyelitis is improbable.