Approach to imaging modalities in the setting of suspected osteomyelitis
- Charles E Spritzer, MD
Charles E Spritzer, MD
- Professor, Department of Radiology
- Chief MSK Division
- Duke University School of Medicine
Radiographic imaging is useful for confirming or excluding the diagnosis of osteomyelitis, delineating the extent of disease, and planning therapy (table 1). Imaging findings must be interpreted in clinical context . Osteomyelitis may occur in any bone; the largest body of data on imaging modalities for evaluation of osteomyelitis comes from the literature on diabetic foot infections.
The benefits and limitations of plain radiographs, magnetic resonance imaging, computed tomography, nuclear modalities, and ultrasonography for the diagnosis of osteomyelitis will be reviewed here. An integrated diagnostic approach to evaluation of adults with suspected osteomyelitis is presented in detail separately. (See "Overview of osteomyelitis in adults", section on 'Clinical approach'.)
PATHOPHYSIOLOGY OF OSTEOMYELITIS
Osteomyelitis can occur as a result of hematogenous seeding, contiguous spread of infection to bone from adjacent soft tissues and joints, or direct inoculation of infection into the bone as a result of trauma or surgery. The most commonly affected adults are poorly controlled diabetics with peripheral neuropathy and vascular insufficiency . (See "Overview of osteomyelitis in adults", section on 'Pathophysiology'.)
In the setting of osteomyelitis, inflammatory exudate in the marrow causes elevated medullary pressure, which compresses vascular channels, leading to ischemia and bone necrosis. If the areas of necrotic bone separate from the remaining viable bone, sequestra are formed. Surviving bone and periosteum ultimately produce a sheath of bone surrounding the area of necrosis, which is referred to as an involucrum. Both the sequestra and involucrum may be apparent radiographically (image 1 and image 2) .
Acute osteomyelitis refers to infection in the bone prior to development of sequestra, usually measured in days or weeks. In some forms of osteomyelitis, development of sequestra is relatively slow (such as vertebral osteomyelitis), while in others the development of sequestra occurs relatively rapidly (such as osteomyelitis in the setting of prosthetic devices or compound fractures) .
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