ACR Appropriateness Criteria ® Suspected Osteomyelitis, Septic Arthritis, or Soft Tissue Infection (Excluding Spine and Diabetic Foot)

Beaman, Francesca D.; Herrmann, Paul; Kransdorf, Mark J.; Adler, Ronald S.; Amini, Behrang; Appel, Marc; Arnold, Erin; Bernard, Stephanie A.; Greenspan, Bennett S.; Lee, Kenneth S.; Tuite, Michael J.; Walker, Eric A.; Ward, Robert James; Wessell, Daniel E.; Weissman, Barbara N.

doi:10.1016/j.jacr.2017.02.008

Cited by 62 publications

(42 citation statements)

References 42 publications

(80 reference statements)

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“…Others tend to be more localised: pain at the site of infection, swelling and erythema [1]. Recognition of these features should prompt clinicians to obtain blood cultures, a full set of blood tests, inflammatory markers, plain x-ray films and a magnetic resonance imaging (MRI) scan [1,8]. Notably, the symptoms of osteomyelitis can either present themselves acutely, or chronically.…”

Section: Osteomyelitismentioning

confidence: 99%

Developments in Antibiotic-Eluting Scaffolds for the Treatment of Osteomyelitis

2020

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Osteomyelitis is a devastating disease caused by the infection of bone tissue and is associated with significant morbidity and mortality. It is treated with antibiotic therapy and surgical debridement. A high dose of systemic antibiotics is often required due to poor bone penetration and this is often associated with unacceptable side-effects. To overcome this, local, implantable antibiotic carriers such as polymethyl methacrylate have been developed. However, this is a non-biodegradable material that requires a second surgery to be removed. Attention has therefore shifted to new antibiotic-eluting scaffolds which can be created with a range of unique properties. The purpose of this review is to assess the level of evidence that exists for these novel local treatments. Although this field is still developing, these strategies seem promising and provide hope for the future treatment of chronic osteomyelitis.

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Section: Osteomyelitismentioning

confidence: 99%

Developments in Antibiotic-Eluting Scaffolds for the Treatment of Osteomyelitis

2020

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“…As a limitation, rst, 67 Ga SPECT/CT is associated with exposure to radiation [24]. We minimized radiation exposure: the radiation dose for whole-body gallium scintigraphy is 14.8 mSv and the computed tomography dose index (CTDI) in our imaging study was 1.3 mGy.…”

Section: Discussionmentioning

confidence: 99%

Feasibility of Hybrid 67Gallium-Citrate SPECT/CT Fusion Imaging for Identifying Patients with Osteomyelitis Awaiting Ostectomy

Kirinoki-Ichikawa

Takagi²,

Miyamoto

et al. 2020

Preprint

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PurposeCo-existence of ischemia and osteomyelitis strongly increase the risk of limb amputation, however, there is no established non-invasive assessment. This single-center cohort study used propensity score-matched analysis. We evaluated the clinical feasibility of hybrid 67Ga-citrate single photon emission computed tomography and X-ray computed tomography (SPECT/CT) for early diagnosis, severity assessment, and prognosis determination in these patients. Method We enrolled consecutive patients with suspected osteomyelitis with mean follow-up of 5.5 years. All patients underwent 67Ga SPECT/CT before and 4 weeks after treatment. Osteomyelitis diagnosis was based on histopathology and bacteriology of surgical sample, bone probing, or imaging follow-up. The diagnostic accuracy of bone resection rates and long-term prognoses were determined based on the target-to-background ratio (TBR). Results Among 90 patients who underwent 67Ga SPECT/CT imaging, the initial average TBR of 67Ga-citrate accumulation was 9.1 ± 12.3. TBR significantly improved following treatment (4.3 ± 3.8, p < 0.01, Wilcoxon test), and the rate of limb salvage was 80%. After propensity score matching, the pre-treatment TBR cutoff for bone resection was 10.1 (sensitivity: 85%, specificity: 82%, area under the curve: 0.87). Significant differences in long-term prognosis following bone resection were also observed often when above this cutoff point (TBR ≥ 10.1, 85.2% vs TBR < 10.1, 17.2%, p < 0.001, log-rank test). Conclusions Coupling of hybrid 67Ga-citrate SPECT/CT fusion imaging by TBR analysis revealed severity thresholds for bone resection, and could be used to assess long-term limb prognosis. 67Ga SPECT/CT fusion imaging may aid in making decisions regarding cases of suspected osteomyelitis.Trial registration:UMIN000022208, date of registration. Registered 1 January 2012, https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000009900

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“…MRI helps identify foreign bodies by the presence of air or metal susceptibility artifact or adjacent edema or fibrosis. MRI may also be used to exclude associated osteomyelitis (see the ACR Appropriateness Criteria Ò topic on "Suspected Osteomyelitis, Septic Arthritis, or Soft Tissue Infection (Excluding Spine and Diabetic Foot)" [81]) or abscess [77].…”

Section: Variant 4: Initial Radiographs Showing Distal Radioulnar Joimentioning

confidence: 99%

ACR Appropriateness Criteria® Acute Hand and Wrist Trauma

Imaging¹,

Torabi

Lenchik

et al. 2019

Journal of the American College of Radiology

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Hand and wrist injuries are common reasons for musculoskeletal-related emergency department visits. Imaging is essential for evaluating many of these injuries. In most cases, conventional radiographs provide sufficient information to guide the treating clinician. This review focuses on seven common variants to guide diagnosis of hand and wrist injuries. In addition to radiographs, appropriate use of CT, MRI, bone scan, and ultrasound are discussed. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

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ACR Appropriateness Criteria ® Suspected Osteomyelitis, Septic Arthritis, or Soft Tissue Infection (Excluding Spine and Diabetic Foot)

Cited by 62 publications

References 42 publications

Developments in Antibiotic-Eluting Scaffolds for the Treatment of Osteomyelitis

Developments in Antibiotic-Eluting Scaffolds for the Treatment of Osteomyelitis

Feasibility of Hybrid 67Gallium-Citrate SPECT/CT Fusion Imaging for Identifying Patients with Osteomyelitis Awaiting Ostectomy

ACR Appropriateness Criteria® Acute Hand and Wrist Trauma

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