Problems in the scintigraphic detection of osteomyelitis in children

99mTc-pyrophosphate studies in 21 children with acute hematogenous osteomyelitis were compared with radiographic, clinical and surgical findings. Eleven 99mTc studies revealed obvious abnormalities, four showed subtle abnormalities, two were misleading, and four were normal. No consistent explanation for the lack of positive radionuclide findings was found. We concluded that pediatric osteomyelitis presents a spectrum of scintigraphic appearances and interpretation is often difficult.