neopulsar
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If pt is suspeted to have osteomyelitis, which on is test of choice if initial X-ray is negative?
MRI
CT
Bone scan
Biopsy
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| neopulsar
Forum Senior
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Kaplan says MRI, UW says scan.
Boards and wards says MRI is gold standard.
I'm confused.
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| neurom
Forum Senior
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MRI!
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| DrVirgo
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well this is according to Kaplan:
First test for a hot red tender swollen leg:
Xray
If Xray is positive do biopsy and give antibiotics and check ESR to monitor therapy.
If Xray is negative do MRI -If MRI is positive do biopsy, if MRI is negative its not osteo.
As for bone scan, it gives too many false positives, BUT you can answer Bone scan on step 2 instead of MRI if the area is NOT red, inflammed, draining, etc.
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| Ivonne
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MRI (test of choice)
Bone scans are sensitive for osteomyelitis but lack specificity.
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| jasmin
Forum Junior
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MRI
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| hero
Forum Elite
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Kaplan Surgery says bone scan.
from medscape article:
The technetium-99m (99mTc) methylene diphosphonate three-phase bone scan is often used to identify osteomyelitis, because it is more sensitive than conventional radiography and can confirm a suspected diagnosis of osteomyelitis within 48 hours after onset of symptoms. The bone scan should be the next imaging study performed in patients with normal radiographs. Classic findings on bone scan are increased blood flow, pooling, and reactive new bone formation. Although sensitivity is good, specificity is poor [see Table 2 -- omitted]. Cellulitis and septic arthritis cannot be differentiated from osteomyelitis on bone scan. False positive results may be seen in patients with previous bone injury, tumor, or infarction. Furthermore, bone scans may remain positive for 6 weeks to 6 months after therapy because of bone metabolism and remodeling. In children with uncomplicated hematogenous osteomyelitis, the bone scan has a high sensitivity and specificity; a positive bone scan strongly suggests osteomyelitis, and a negative scan in children older than 3 years excludes the diagnosis.16 Sensitivity, however, is lower in neonates and in patients with sickle cell anemia.
Computed Tomography and Magnetic Resonance Imaging
Both CT and MRI have excellent sensitivity and resolution and allow simultaneous evaluation of bone and surrounding soft tissues. CT reliably detects sequestra and devitalized bone and is useful for evaluating patients with osteomyelitis of the skull. However, CT is prone to image degradation and is less specific than other tests. MRI, with its excellent specificity, is helpful in distinguishing bone tumor or infarction from osteomyelitis.20 Furthermore, MRI is particularly reliable in distinguishing normal areas from abnormal areas when surgery is being planned for diabetic patients with osteomyelitis.21 In addition, MRI is the technique of choice for detecting and assessing the site and extent of infection in the spine. However, the expense of MRI precludes its use on a routine basis. A limited MRI scan with specialized views and minimal use of gadolinium contrast can be used to control costs.22 Metallic prostheses exclude the use of MRI and distort image reflection on CT, thereby obscuring early changes of infection.
http://www.medscape.com/viewarticle/534828
Edited by hero on 01/10/08 - 03:21 PM
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| dr_gladiator
Forum Junior
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according to u world.. bone scan is ix of choice for osteomyelitis
but for vertebral osteiomyelitis and diabetic foot MRI is ix of choice.
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| neopulsar
Forum Senior
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Posts: 82
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Alright...thanks guys.
So, MRI is the "test of choice" and scan is the "next step" when X-ray is negative.
I guess I misinterpreted the UW question; I thought it was asking about the best test when it actually asked about the next step.
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| RX 135
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gallium scan is specific cause it binds to neutrophil which accumulate at the site of infection...
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| DrVirgo
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Can anyone sum this up in a few easy sentences so we can remember them as an algorithm or rules? Thanks.
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| multifactorial
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sice X-rays take around 4-6 weeks to get positive we do a bone scan as it outlines any bony abnormalities very early.i dont know if MRI is superior to a bone scan.again i think in kaplan paeds osteomyelitis it is written that the best test is a subperiosteal bone culture.
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| RX 135
Forum Elite
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te scan is non specific it detects all bone lesion but not specific for a particular disease
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| gatita007
Forum Junior
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MRI 
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