[Diagnostic imaging of acute and chronic osteomyelitis]

For the diagnosis of acute and chronic osteomyelitis imaging methods have become essential. This paper reviews the potential of the different imaging modalities. When there is clinical suspicion of acute osteomyelitis plain films are still the mainstay of diagnosis. In newborns and young children this primary diagnostic modality will be supplemented by sonography. If there is a need for further imaging, MRI and the different scintigraphic methods may be used interchangeably. However, for the spine and other complex anatomical regions MRI is preferred. In contrast, three-phase bone scanning is mostly accepted as the primary additional tool to radiography and sonography in the newborn and in small children. If an abscess is suspected, MRI is the primary imaging modality. In cases of chronic osteomyelitis radiography still forms the basis for obtaining information about the bone. Further imaging is regularly needed, not only because of its diagnostic value but also because radiographs do not demonstrate the extent of lesions correctly. The evaluation of disease extent in bone is a domain of MRI, while scintigraphic methods, like 111In leucocyte scintigraphy and MRI, are of equivalent diagnostic value. CT may have its role in disclosing a sequestrum when radiographs and MRI are equivocal.