Single-photon emission computed tomography (SPECT)/CT offers improved characterization of osseous pathology compared to planar imaging [53]. 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 disease [53]. Whole-body bone scan is typically helpful 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, 100% (7 of 7) patients with osteomyelitis had increased uptake corresponding to the site of involvement [56]. In one study of 213 children referred for skeletal scintigraphy because of 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, although it should be noted that bone scan was limited regarding soft- tissue and articular pathology [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].
Osteomyelitis or Septic Arthritis Child Excluding Axial Skeleton PCAs. Single-photon emission computed tomography (SPECT)/CT offers improved characterization of osseous pathology compared to planar imaging [53]. 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 disease [53]. Whole-body bone scan is typically helpful 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, 100% (7 of 7) patients with osteomyelitis had increased uptake corresponding to the site of involvement [56]. In one study of 213 children referred for skeletal scintigraphy because of 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, although it should be noted that bone scan was limited regarding soft- tissue and articular pathology [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].