However, caution must be used in the recent postoperative or posttrauma period because bone marrow and soft tissue edema may persist and mimic infection [21]. IV contrast administration is preferred to help evaluate the soft tissues [27,32]. US Area of Interest US may be used in detection of soft tissue abnormalities such as abscess or fistulous tracts. However, assessment of the underlying bone is typically limited with US findings of osteomyelitis either not visualized or nonspecific [28,33]. WBC Scan and Sulfur Colloid Scan Area of Interest Combining a sulfur colloid scan with a WBC scan may reduce false positive results from normal WBC accumulation in bone marrow adjacent to orthopedic hardware. No studies were found that specifically investigated accuracy of combined WBC scan and sulfur colloid scan in diagnosing osteomyelitis associated with extra-articular hardware. Because sulfur colloid is a bone marrow imaging technique, there is no added benefit for assessment of soft tissue infection associated with orthopedic hardware. The addition of SPECT/CT hybrid imaging may increase ability to localize infection in cases with orthopedic hardware. WBC Scan Area of Interest A systematic review by Govaert et al [21] found that a WBC scan for posttraumatic osteomyelitis had sensitivity ranging from 50% to 100% and specificity ranging from 40% to 97%. The addition of SPECT/CT hybrid imaging may increase ability to localize infection in cases with orthopedic hardware. Variant 5: Suspected septic arthritis with arthroplasty or other implanted intra-articular surgical hardware. Initial radiographs normal or with findings suggestive of septic arthritis with arthroplasty or other implanted intra-articular surgical hardware. Next imaging study. For septic arthritis, the body regions covered are ankle, elbow, hip, knee, shoulder, wrist.
Suspected Osteomyelitis Septic Arthritis or Soft Tissue Infection Excluding Spine and Diabetic Foot PCAs. However, caution must be used in the recent postoperative or posttrauma period because bone marrow and soft tissue edema may persist and mimic infection [21]. IV contrast administration is preferred to help evaluate the soft tissues [27,32]. US Area of Interest US may be used in detection of soft tissue abnormalities such as abscess or fistulous tracts. However, assessment of the underlying bone is typically limited with US findings of osteomyelitis either not visualized or nonspecific [28,33]. WBC Scan and Sulfur Colloid Scan Area of Interest Combining a sulfur colloid scan with a WBC scan may reduce false positive results from normal WBC accumulation in bone marrow adjacent to orthopedic hardware. No studies were found that specifically investigated accuracy of combined WBC scan and sulfur colloid scan in diagnosing osteomyelitis associated with extra-articular hardware. Because sulfur colloid is a bone marrow imaging technique, there is no added benefit for assessment of soft tissue infection associated with orthopedic hardware. The addition of SPECT/CT hybrid imaging may increase ability to localize infection in cases with orthopedic hardware. WBC Scan Area of Interest A systematic review by Govaert et al [21] found that a WBC scan for posttraumatic osteomyelitis had sensitivity ranging from 50% to 100% and specificity ranging from 40% to 97%. The addition of SPECT/CT hybrid imaging may increase ability to localize infection in cases with orthopedic hardware. Variant 5: Suspected septic arthritis with arthroplasty or other implanted intra-articular surgical hardware. Initial radiographs normal or with findings suggestive of septic arthritis with arthroplasty or other implanted intra-articular surgical hardware. Next imaging study. For septic arthritis, the body regions covered are ankle, elbow, hip, knee, shoulder, wrist.