[Nuclear medicine diagnosis of osteomyelitis]

Scintigraphic imaging identifies pathophysiological processes; in other words it assesses regional perfusion, permeability, leukocytic accumulation and bone turnover. These processes precede morphological changes and this accounts for the high sensitivity of nuclear medicine procedures as well as the low specificity for the differential diagnosis of different diseases with similar pathophysiological characteristics. This review (1) describes and evaluates the currently used scintigraphic procedures, (2) suggests their differential use in certain clinical settings in comparison with alternative radiological methods and (3) addresses new developments in diagnosis using nuclear medicine procedures. In summary, we advise dynamic bone scanning as a primary scintigraphic investigation. A negative scan excludes osteomyelitis in most cases. The comparison is made with conventional radiology and clinical history. In cases with short clinical histories (= granulocytic inflammation), leukocyte scintigraphy should be the next diagnostic step; in chronic processes (lymphomonocytic inflammation), gallium scintigraphy is advisable. Other scintigraphic methods might be of additional use in experienced hands. SPECT is useful for clarifying inconclusive planar scans of the head, spine and large joints.