Hip US for the purpose of identifying joint effusion can be performed with high sensitivity and specificity [48]. In one study, nearly 80% of pediatric patients with hip septic arthritis required US imaging alone to guide their management [45]. US in evaluation of osteomyelitis is limited in its ability to assess the osseous structures but can identify abutting inflammatory changes affecting the soft tissues such as periosteal elevation and subperiosteal collections [40,49,50]. Bone Scan Whole Body Whole-body bone scan is typically recommended when scintigraphy is used for suspected osteomyelitis, particularly if there is a fever of unknown origin or bacteremia [54]. One study assessed the accuracy of bone scan for the diagnosis of suspected acute hematogenous osteomyelitis and septic arthritis in 86 children, using whole- body and selected static images, without blood flow or blood pool views [55]. Bone scan findings were correlated with the final diagnosis in 34 sites of septic arthritis and in 62 sites of osteomyelitis. Bone scan accuracy was 81%. Positive predictive value was 82% for those sites with increased activity and 100% for those sites with decreased activity. Negative predictive value was 63%. In another smaller study, 9 patients who underwent whole-body scan, Osteomyelitis or Septic Arthritis-Child 100% (7 of 7) patients with osteomyelitis had increased uptake corresponding to the site of involvement [56]. SPECT/CT offers improved characterization of osseous pathology compared to planar imaging [59]. MRI is generally considered preferable in detection of early manifestations of osteomyelitis, as well as infection of the surrounding soft tissues, because of the rapid progression of the disease [53]. Bone Scan Whole Body and 3-Phase Bone Scan Area of Interest Whole-body bone scan is typically recommended when scintigraphy is used for suspected osteomyelitis, particularly if there is a fever of unknown origin or bacteremia [54].
Osteomyelitis or Septic Arthritis Child Excluding Axial Skeleton PCAs. Hip US for the purpose of identifying joint effusion can be performed with high sensitivity and specificity [48]. In one study, nearly 80% of pediatric patients with hip septic arthritis required US imaging alone to guide their management [45]. US in evaluation of osteomyelitis is limited in its ability to assess the osseous structures but can identify abutting inflammatory changes affecting the soft tissues such as periosteal elevation and subperiosteal collections [40,49,50]. Bone Scan Whole Body Whole-body bone scan is typically recommended when scintigraphy is used for suspected osteomyelitis, particularly if there is a fever of unknown origin or bacteremia [54]. One study assessed the accuracy of bone scan for the diagnosis of suspected acute hematogenous osteomyelitis and septic arthritis in 86 children, using whole- body and selected static images, without blood flow or blood pool views [55]. Bone scan findings were correlated with the final diagnosis in 34 sites of septic arthritis and in 62 sites of osteomyelitis. Bone scan accuracy was 81%. Positive predictive value was 82% for those sites with increased activity and 100% for those sites with decreased activity. Negative predictive value was 63%. In another smaller study, 9 patients who underwent whole-body scan, Osteomyelitis or Septic Arthritis-Child 100% (7 of 7) patients with osteomyelitis had increased uptake corresponding to the site of involvement [56]. SPECT/CT offers improved characterization of osseous pathology compared to planar imaging [59]. MRI is generally considered preferable in detection of early manifestations of osteomyelitis, as well as infection of the surrounding soft tissues, because of the rapid progression of the disease [53]. Bone Scan Whole Body and 3-Phase Bone Scan Area of Interest Whole-body bone scan is typically recommended when scintigraphy is used for suspected osteomyelitis, particularly if there is a fever of unknown origin or bacteremia [54].