Initial radiographs normal or with findings suggestive of osteomyelitis or soft tissue infection with implanted extra-articular surgical hardware. Next imaging study. For osteomyelitis and soft tissue infection, the body regions covered are ankle, elbow, hip, knee, shoulder, wrist. 3-Phase Bone Scan and WBC Scan and Sulfur Colloid Scan Area of Interest There is insufficient evidence to support the use of 3-phase bone scan, WBC scan, and sulfur colloid scan for the evaluation of infection of extra-articular surgical hardware in the absence of known fluid collection or abscess. 3-Phase Bone Scan and WBC Scan Area of Interest A 3-phase bone scan has low specificity for infection in the setting of trauma or recent surgery. A WBC scan should be considered in patients with a low suspicion of infection who have positive findings on 3-phase bone scan [21]. 3-Phase Bone Scan Area of Interest A meta-analysis by Wang et al [17] found that a 3-phase bone scan had sensitivity of 83% but specificity of <50%. In the setting of prior surgery or trauma, the specificity of 3-phase bone scan is likely even lower because osseous remodeling will result in radiotracer uptake [21]. Although studies have shown that SPECT/CT aids in anatomic localization of infection, findings often remain equivocal [19]. Suspected Osteomyelitis, Septic Arthritis There is insufficient evidence to support the use of image-guided aspiration for evaluation of infection of extra- articular surgical hardware in the absence of known fluid collection or abscess. CT Area of Interest CT is useful in the evaluation of postsurgical complications including hardware fracture, periprosthetic osteolysis, and fracture nonunion [29]. Osseous changes of osteomyelitis can be visualized with CT, although these findings are often nonspecific, particularly if there has been recent trauma or surgery.
Suspected Osteomyelitis Septic Arthritis or Soft Tissue Infection Excluding Spine and Diabetic Foot PCAs. Initial radiographs normal or with findings suggestive of osteomyelitis or soft tissue infection with implanted extra-articular surgical hardware. Next imaging study. For osteomyelitis and soft tissue infection, the body regions covered are ankle, elbow, hip, knee, shoulder, wrist. 3-Phase Bone Scan and WBC Scan and Sulfur Colloid Scan Area of Interest There is insufficient evidence to support the use of 3-phase bone scan, WBC scan, and sulfur colloid scan for the evaluation of infection of extra-articular surgical hardware in the absence of known fluid collection or abscess. 3-Phase Bone Scan and WBC Scan Area of Interest A 3-phase bone scan has low specificity for infection in the setting of trauma or recent surgery. A WBC scan should be considered in patients with a low suspicion of infection who have positive findings on 3-phase bone scan [21]. 3-Phase Bone Scan Area of Interest A meta-analysis by Wang et al [17] found that a 3-phase bone scan had sensitivity of 83% but specificity of <50%. In the setting of prior surgery or trauma, the specificity of 3-phase bone scan is likely even lower because osseous remodeling will result in radiotracer uptake [21]. Although studies have shown that SPECT/CT aids in anatomic localization of infection, findings often remain equivocal [19]. Suspected Osteomyelitis, Septic Arthritis There is insufficient evidence to support the use of image-guided aspiration for evaluation of infection of extra- articular surgical hardware in the absence of known fluid collection or abscess. CT Area of Interest CT is useful in the evaluation of postsurgical complications including hardware fracture, periprosthetic osteolysis, and fracture nonunion [29]. Osseous changes of osteomyelitis can be visualized with CT, although these findings are often nonspecific, particularly if there has been recent trauma or surgery.