In one study of 213 children referred for skeletal scintigraphy because of a suspicion for acute hematogenous osteomyelitis who underwent a 3-phase bone scan of the area of interest along with whole-body delayed images, accurate diagnosis was made in 84% of cases without the need for MRI, including 92% of those diagnosed with osteomyelitis [57]. In another study of 65 children who underwent whole-body scan with focused evaluations of the area of interest and the contralateral side, 23 patients who were classified as having osteomyelitis all had abnormal bone scans [58]. SPECT/CT offers improved characterization of osseous pathology compared with 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, but SPECT/CT offers improved characterization of osseous pathology compared with planar imaging [53,59]. Image-Guided Aspiration Area of Interest Primary differential considerations when a joint effusion is present in the absence of trauma are transient synovitis and septic arthritis. Though most nontraumatic hip joint effusions are secondary to transient synovitis, early diagnosis of septic arthritis is extremely important in preventing complications, and US-guided hip aspiration is considered highly accurate for diagnosis [43,61]. In one study, 100% of children were confirmed to have septic hip arthritis via bedside joint aspiration and were able to avoid arthrotomy. However, it should be noted than US guidance for aspiration was only provided in one case, and the remainder were performed using anatomic landmarks and without imaging guidance [62]. In the setting of confirmed transient synovitis, children who underwent US- guided joint aspiration experienced shorter duration of stay and shorter duration of a limp compared with those who did not undergo joint aspiration [61].
Osteomyelitis or Septic Arthritis Child Excluding Axial Skeleton PCAs. In one study of 213 children referred for skeletal scintigraphy because of a suspicion for acute hematogenous osteomyelitis who underwent a 3-phase bone scan of the area of interest along with whole-body delayed images, accurate diagnosis was made in 84% of cases without the need for MRI, including 92% of those diagnosed with osteomyelitis [57]. In another study of 65 children who underwent whole-body scan with focused evaluations of the area of interest and the contralateral side, 23 patients who were classified as having osteomyelitis all had abnormal bone scans [58]. SPECT/CT offers improved characterization of osseous pathology compared with 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, but SPECT/CT offers improved characterization of osseous pathology compared with planar imaging [53,59]. Image-Guided Aspiration Area of Interest Primary differential considerations when a joint effusion is present in the absence of trauma are transient synovitis and septic arthritis. Though most nontraumatic hip joint effusions are secondary to transient synovitis, early diagnosis of septic arthritis is extremely important in preventing complications, and US-guided hip aspiration is considered highly accurate for diagnosis [43,61]. In one study, 100% of children were confirmed to have septic hip arthritis via bedside joint aspiration and were able to avoid arthrotomy. However, it should be noted than US guidance for aspiration was only provided in one case, and the remainder were performed using anatomic landmarks and without imaging guidance [62]. In the setting of confirmed transient synovitis, children who underwent US- guided joint aspiration experienced shorter duration of stay and shorter duration of a limp compared with those who did not undergo joint aspiration [61].