3-Phase Bone Scan Pelvis and Lower Extremity Bone scan has been reported to have a high sensitivity for the diagnosis of osteomyelitis, albeit with lower reported specificity. However, its utility is greatest when symptoms cannot be localized. The main limitation of bone scan with a localized examination is in the detection of soft-tissue abscess [39,41]. CT Lower Extremity CT has decreased sensitivity in the detection of bone marrow pathology and decreased soft-tissue contrast compared to MRI [63-65]. CT with IV contrast can be considered when soft-tissue infection is of concern or in children with contraindications to MRI [66]. Acutely Limping Child Up To Age 5 MRI Lower Extremity MRI, given its sensitivity to musculoskeletal injury and inflammation, has high accuracy in diagnosing infection, specifically osteomyelitis and pyomyositis [43,76]. Contrast administration improves detection of soft-tissue abscesses in selected patients with soft-tissue edema [50,51]. Because of low bone scan sensitivity for soft-tissue pathology, MRI may sometimes need to be obtained after a positive bone scan for further evaluation of soft- tissues pathology mainly to detect any abscess formation that requires drainage [41]. Contrast administration in the MRI evaluation of suspected soft-tissue or osseous infection does not increase sensitivity or specificity but may increase reader confidence and better delineate abscesses [50,51]. Contrast administration during MRI should be considered in specific cases to improve detection of small abscesses when there is significant soft-tissue edema [50,51]. The need for sedation in young patients undergoing MRI is a consideration. MRI Whole-Body There is no relevant literature regarding the use of whole-body MRI in the initial evaluation of acute limp with localized symptoms to the lower extremity and concern for infection. Whole-body MRI may be very sensitive for osteomyelitis.
Acutely Limping Child Up To Age 5 PCAs. 3-Phase Bone Scan Pelvis and Lower Extremity Bone scan has been reported to have a high sensitivity for the diagnosis of osteomyelitis, albeit with lower reported specificity. However, its utility is greatest when symptoms cannot be localized. The main limitation of bone scan with a localized examination is in the detection of soft-tissue abscess [39,41]. CT Lower Extremity CT has decreased sensitivity in the detection of bone marrow pathology and decreased soft-tissue contrast compared to MRI [63-65]. CT with IV contrast can be considered when soft-tissue infection is of concern or in children with contraindications to MRI [66]. Acutely Limping Child Up To Age 5 MRI Lower Extremity MRI, given its sensitivity to musculoskeletal injury and inflammation, has high accuracy in diagnosing infection, specifically osteomyelitis and pyomyositis [43,76]. Contrast administration improves detection of soft-tissue abscesses in selected patients with soft-tissue edema [50,51]. Because of low bone scan sensitivity for soft-tissue pathology, MRI may sometimes need to be obtained after a positive bone scan for further evaluation of soft- tissues pathology mainly to detect any abscess formation that requires drainage [41]. Contrast administration in the MRI evaluation of suspected soft-tissue or osseous infection does not increase sensitivity or specificity but may increase reader confidence and better delineate abscesses [50,51]. Contrast administration during MRI should be considered in specific cases to improve detection of small abscesses when there is significant soft-tissue edema [50,51]. The need for sedation in young patients undergoing MRI is a consideration. MRI Whole-Body There is no relevant literature regarding the use of whole-body MRI in the initial evaluation of acute limp with localized symptoms to the lower extremity and concern for infection. Whole-body MRI may be very sensitive for osteomyelitis.