aimhigh
Forum Elite
Topics: 22
Posts: 148
|
Hi, I am confused with the diagnostic tool for osteomyelitis: see on the initial stage, x-ray often fails to capture the disease or merely reveals soft tissue swelling for osteomyelitis. So if x-ray is negative, which step should be the next: 3-phase technieum bone scan or MRI? Please reply, thanks!
|
| sobia naeem
Forum Elite
Topics: 30
Posts: 303
|
i would go for bone scan.
|
| achilles
Forum Guru
Topics: 89
Posts: 1,224
|
for the next step, i agree with sobia-technetium bone scan(which is sensitive but not very specific)...the primary investigations are X-ray ( does not show changes until 2 weeks after the infection) and bone scan(which is not very specific).
if the diagnosis is unclear after this...the diagnostic tool is MRI ( very sensitive and specific and also delineates the anatomic extension of the infection. MRI has equal sensitivity as a bone scan and greater specificity.
___________________
" it's not whether you get knocked down, it's whether you get up"
" i have miles to go before i sleep "
|
| aimhigh
Forum Elite
Topics: 22
Posts: 148
|
thanks, Sobia and Achilles! Achilles, thanks for your thorough explanations. The confusion haunting me is the fact that bone scan is not good if there is serious inflammation around....but I would go with you, bone scan first then if not centain just go with MRI.
|
| Flying Pig
Forum Newbie
Topics: 1
Posts: 6
|
So I am confused. If bone scan is neither sensitive nor specific compared with MRI, why not MRI directly? Besides being radioactive, bone scan is also expensive. There must be something with bone scan that's superior than MRI.
|
| cyra
Moderator
Topics: 29
Posts: 844
|
I agree with Flying Pig....Why not MRI as the first choice?
The management of Osteomyelitis in UW is different from what you see in kaplan.
I had been thinking of posting the same query....anyways...I'll look it up and see if I come up with something.
|
| aimhigh
Forum Elite
Topics: 22
Posts: 148
|
3 phase technieum bone scan is very sensitive to pick up osteomyelitis but just high false positive in the context of serious inflammation. MRI seems more superior over bone scan in spine and foot osteomyelitis....according to what I am understanding so far
|
| achilles
Forum Guru
Topics: 89
Posts: 1,224
|
exactly what went thru my mind cyra,when i was reading about the diagnosis of osteomyelitis...why not just do one test- MRI !! but those are the given guidelines - primary investigations are X-ray and bone scan and if the diagnosis is still unclear, then do an MRI.
and there must be some more detail to why this protocol is followed...aimhigh has shed some more light on this topic...lets see if we can find the answer to this "why" ( so many why's still unanswered !! )
___________________
" it's not whether you get knocked down, it's whether you get up"
" i have miles to go before i sleep "
|
| Rasul
Forum Guru
Topics: 56
Posts: 485
|
What I remember form Kaplan explanations: If the pt has open wound doing bone scan is a hassle coz ulcers and inflammation can give false+ answer for osteomyelitis, meaning you cannot definitely distinguish if the infectious process involves only soft tissues, it might look like it goes all the way deep to the bone. Whereas MRI will tell You precisely if the bone is involved or it's an isolated soft tissue wound.So in the case of draining wound and suspected osteomyelitis bone scan can be omitted, MRI should be performed.
But if there's no open wound, bone scan comes before MRI.
|
| aimhigh
Forum Elite
Topics: 22
Posts: 148
|
That's more specific! Thanks, Rasul!
|
| achilles
Forum Guru
Topics: 89
Posts: 1,224
|
gr8 ! thanks rasul. now it makes sense.
___________________
" it's not whether you get knocked down, it's whether you get up"
" i have miles to go before i sleep "
|
| Jinx
Forum Elite
Topics: 17
Posts: 316
|
latest kaplan notes do not say that a bone scan should be done--they recommend MRI directly following xray--since tho scan and MRI have same sensitivity--specificity of MRI is greater
___________________
Life is a journey--enjoy the drive!!
|
| jvo_md
Forum Senior
Topics: 22
Posts: 189
|
BONE SCAN!!!
|
|
| |
| | | | | | | | | | | | | |
