3-Phase Bone Scan Area of Interest There is insufficient evidence to support the use of a 3-phase bone scan area of interest for the initial evaluation of osteomyelitis, septic arthritis, or soft tissue infections. CT Area of Interest There is insufficient evidence to the support the use of CT area of interest for the initial evaluation of osteomyelitis, septic arthritis, or soft tissue infections. MRI Area of Interest There is insufficient evidence to support the use of MRI area of interest for the initial evaluation of osteomyelitis, septic arthritis, or soft tissue infections. Radiography Area of Interest The literature indicates that radiographs should be used for the initial evaluation of musculoskeletal infections, including osteomyelitis, septic arthritis, and soft tissue infection. Erosions and periosteal reaction are common findings in acute osteomyelitis, whereas bone sclerosis is commonly associated with chronic osteomyelitis. In early acute osteomyelitis (<14 days), radiographs may be normal or show only mild soft tissue swelling [5]. Soft tissue swelling, joint effusion, ulcers, effacement of fat planes, gas, and foreign bodies may indicate soft tissue infections or septic arthritis [2]. Many radiographic findings are not specific for infection, and a differential diagnosis may include tumors, trauma, arthritides, metabolic conditions, cardiovascular etiologies, and venous insufficiency or thrombosis. However, obtaining the initial radiograph provides an excellent overview of the anatomic area of interest and can exclude fractures and tumors as the cause of swelling or pain. Radiographs also help with the interpretation of future imaging studies such as CT, MRI, ultrasound (US), and nuclear medicine scans [6]. US Area of Interest There is insufficient evidence to support the use of US area of interest for the initial evaluation of osteomyelitis, septic arthritis, or soft tissue infections.
Suspected Osteomyelitis Septic Arthritis or Soft Tissue Infection Excluding Spine and Diabetic Foot PCAs. 3-Phase Bone Scan Area of Interest There is insufficient evidence to support the use of a 3-phase bone scan area of interest for the initial evaluation of osteomyelitis, septic arthritis, or soft tissue infections. CT Area of Interest There is insufficient evidence to the support the use of CT area of interest for the initial evaluation of osteomyelitis, septic arthritis, or soft tissue infections. MRI Area of Interest There is insufficient evidence to support the use of MRI area of interest for the initial evaluation of osteomyelitis, septic arthritis, or soft tissue infections. Radiography Area of Interest The literature indicates that radiographs should be used for the initial evaluation of musculoskeletal infections, including osteomyelitis, septic arthritis, and soft tissue infection. Erosions and periosteal reaction are common findings in acute osteomyelitis, whereas bone sclerosis is commonly associated with chronic osteomyelitis. In early acute osteomyelitis (<14 days), radiographs may be normal or show only mild soft tissue swelling [5]. Soft tissue swelling, joint effusion, ulcers, effacement of fat planes, gas, and foreign bodies may indicate soft tissue infections or septic arthritis [2]. Many radiographic findings are not specific for infection, and a differential diagnosis may include tumors, trauma, arthritides, metabolic conditions, cardiovascular etiologies, and venous insufficiency or thrombosis. However, obtaining the initial radiograph provides an excellent overview of the anatomic area of interest and can exclude fractures and tumors as the cause of swelling or pain. Radiographs also help with the interpretation of future imaging studies such as CT, MRI, ultrasound (US), and nuclear medicine scans [6]. US Area of Interest There is insufficient evidence to support the use of US area of interest for the initial evaluation of osteomyelitis, septic arthritis, or soft tissue infections.