x ray/bone scan/mri

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Prep4USMLE Forum » USMLE Step 2 CK Forum » Internal Medicine Forum

x ray/bone scan/mri

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sadiq naveed
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Topics: 42
Posts: 235

02/25/08 - 02:45 AM

hi when to use all these modalities in osteomyelitis and bone cancer

which is best in term of inital.sensitive n specific test

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simi
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Topics: 53
Posts: 358

02/26/08 - 10:16 PM

i am not sure about bone cancer...but for osteomyelitis, initial test is X-ray coz it is more easily obtained, easily read n inexpensive...perisosteal elevation is the first abnormality visible.

Bone scan and MRI r the earliest methods to detect osteomyelitis.Both have equal sensitivity for early pick up but MRI can allow better differentiation between overlying soft tissue n bone.

If Xray shows nothing then we can go for MRI.

DrVirgo
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02/27/08 - 06:02 PM

This is the management of Osteomyelitys according to UW.

1. Take blood cultures and start empiric Antibiotics.
2. DO X-ray as the initial test (however X ray may not show anything in the first 1-2 weeks)
3. If Xray is negative, next test is a 3 Phase Technitium Bone Scan.
4. If Blood Cultures came out negative, do a Needle Bx. to ID the organism.
5. MRI is expensive, but it is the test of choice for Osteomyelitis of the Vertebrae and Foot.

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nyimalay
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02/27/08 - 07:52 PM

To summarize,
For OM, go ahead with Xray.
If inconclusive, MRI for spine and foot, Bone scan for others.

For malignancy,
If not obvious, start with bone scan (sensitive, not specific) , confirm with X ray.
If obvious, can do X ray right away.

Please add other opinions if any.

DrVirgo
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03/03/08 - 01:13 PM

nyimalay wrote:
To summarize,
For OM, go ahead with Xray.
If inconclusive, MRI for spine and foot, Bone scan for others.

For malignancy,
If not obvious, start with bone scan (sensitive, not specific) , confirm with X ray.
If obvious, can do X ray right away.

Please add other opinions if any.

For example: In a case with trauma to the leg, a few days ago and you suspect osteomyelitis, would you start with X-ray knowing that it usually doesn't show anything for the first 1-2 weeks OR would you go straight to Bone Scan?

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