"Cold" bone scans in acute osteomyelitis

Abstract

The diagnosis of acute osteomyelitis is often very difficult during the first 24 to 48 hours. Bone scanning has been a useful adjunct in this diagnosis by demonstrating increased uptake in the area or areas of involvement. Occasionally the pathological area is "cold" on scanning, which may lead to a misdiagnosis. This paper presents three cases demonstrating this unusual finding.

Acute haematogenous osteomyelitis in children

“…33 34 New bone formation and blood flow are important requirements for the uptake of radionuclide on to bone; hence any mechanism that interferes with hyperaemia or osteoblastic activity (for example, thrombosis and tamponade of the affected bone) is likely to produce an image of decreased activity. 34 Ultrasound cannot evaluate bone marrow (ultrasonic waves cannot penetrate bone cortex) and hence its use in the diagnosis of osteomyelitis is limited. Nevertheless, ultrasonography is a useful investigation for visualising subperiosteal collections and joint effusions, and it can aid in the aspiration of soft tissue fluid and joint.…”

Orbital infarction in sickle cell disease

“…Rarely, cold osteomyelitis has been reported [4]. Tracer accumulation depends upon new bone formation and blood flow.…”

Skeletal Scintigraphy in the Multimodality Assessment of Young Children With Acute Skeletal Symptoms

“…Low uptake indicating regional ischemia occasionally occurs and is referred to as "cold" osteomyelitis. 13,14 The emergence of MRI has raised questions regarding how to image children with suspected acute osteomyelitis. 15,16 Acute osteomyelitis can be detected by MRI within 24 to 48 hours of the first symptom.…”