There is no added benefit in performing multiphase CT imaging before and after IV contrast administration in the evaluation of infection. MRI Area of Interest MRI is highly accurate for detection of acute osteomyelitis. Noncontrast MRI has high sensitivity and specificity in the diagnosis of osteomyelitis. MRI is sensitive at depicting marrow signal changes of acute osteomyelitis. Additionally MRI provides excellent evaluation of the adjacent soft tissues including abscess or fistulas [13,23-26]. The use of IV contrast does not improve diagnosis of peripheral osteomyelitis; however, its use may improve the evaluation of soft tissue infections [27]. US Area of Interest US is of limited benefit in the diagnosis of osteomyelitis. Although findings such as juxtacortical fluid collections and fistulous tracts may be seen, these findings are not specific for osteomyelitis [28]. WBC Scan and Sulfur Colloid Scan Area of Interest A sulfur colloid scan is often performed when WBC scan results are equivocal. If osteomyelitis is present, a sulfur colloid scan will show no radiotracer activity in areas of WBC scan activity. WBC scan combined with marrow imaging has been reported up to 90% accurate in diagnosing osteomyelitis [18]. Disadvantages include low spatial resolution [15,16]. WBC Scan Area of Interest A WBC scan has been reported to have variable sensitivity and specificity when performed alone in the evaluation of osteomyelitis [17]. The addition of SPECT/CT has been suggested to increase the accuracy of WBC scan for the diagnosis of osteomyelitis. When a WBC scan is positive on planar images, SPECT/CT can be performed for more accurate localization of infection [15,21]. Variant 4: Suspected osteomyelitis or soft tissue infection with implanted extra-articular surgical hardware.
Suspected Osteomyelitis Septic Arthritis or Soft Tissue Infection Excluding Spine and Diabetic Foot PCAs. There is no added benefit in performing multiphase CT imaging before and after IV contrast administration in the evaluation of infection. MRI Area of Interest MRI is highly accurate for detection of acute osteomyelitis. Noncontrast MRI has high sensitivity and specificity in the diagnosis of osteomyelitis. MRI is sensitive at depicting marrow signal changes of acute osteomyelitis. Additionally MRI provides excellent evaluation of the adjacent soft tissues including abscess or fistulas [13,23-26]. The use of IV contrast does not improve diagnosis of peripheral osteomyelitis; however, its use may improve the evaluation of soft tissue infections [27]. US Area of Interest US is of limited benefit in the diagnosis of osteomyelitis. Although findings such as juxtacortical fluid collections and fistulous tracts may be seen, these findings are not specific for osteomyelitis [28]. WBC Scan and Sulfur Colloid Scan Area of Interest A sulfur colloid scan is often performed when WBC scan results are equivocal. If osteomyelitis is present, a sulfur colloid scan will show no radiotracer activity in areas of WBC scan activity. WBC scan combined with marrow imaging has been reported up to 90% accurate in diagnosing osteomyelitis [18]. Disadvantages include low spatial resolution [15,16]. WBC Scan Area of Interest A WBC scan has been reported to have variable sensitivity and specificity when performed alone in the evaluation of osteomyelitis [17]. The addition of SPECT/CT has been suggested to increase the accuracy of WBC scan for the diagnosis of osteomyelitis. When a WBC scan is positive on planar images, SPECT/CT can be performed for more accurate localization of infection [15,21]. Variant 4: Suspected osteomyelitis or soft tissue infection with implanted extra-articular surgical hardware.