The role of diagnostic imaging in the evaluation of suspected osteomyelitis in the foot: A critical review

Harmer, James L.; Pickard, James M.; Stinchcombe, Simon

doi:10.1016/j.foot.2010.11.005

Cited by 15 publications

(9 citation statements)

References 13 publications

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“…Although radiographs are recommended as an initial screening examination, they are insensitive in the detection of acute osteomyelitis. Subtle early radiographic findings of osteomyelitis include soft-tissue swelling and obscuration of the fat planes [9]. After 1 to 2 weeks, osteolysis, cortical loss, and periosteal reaction ensue [8].…”

Section: Discussion Of Imaging Modalities By Variantmentioning

confidence: 99%

“…ionizing radiation, drawbacks include potential difficulty in distinguishing infection from reactive inflammation, artifact produced by orthopedic hardware, and patient contraindications such as non-MRI-compatible implanted devices or severe claustrophobia. MRI has a 100% negative predictive value for excluding osteomyelitis; a normal marrow signal reliably excludes infection [7,9]. Positive cases show decreased T1-weighted bone marrow signal, with increased signal on fluid-sensitive sequences such as T2-weighted fat-saturated and short tau inversion recovery.…”

Section: Overview Of Imaging Modalitiesmentioning

confidence: 99%

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

Beaman

Herrmann

Kransdorf

et al. 2017

Journal of the American College of Radiology

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Infection of the musculoskeletal system is a common clinical problem. Differentiating soft tissue from osseous infection often determines the appropriate clinical therapeutic course. Radiographs are the recommend initial imaging examination, and although often not diagnostic in acute osteomyelitis, can provide anatomic evaluation and alternative diagnoses influencing subsequent imaging selection and interpretation. MRI with contrast is the examination of choice for the evaluation of suspected osteomyelitis, and MRI, CT, and ultrasound can all be useful in the diagnosis of soft tissue infection. CT or a labeled leukocyte scan and sulfur colloid marrow scan combination are alternative options if MRI is contraindicated or extensive artifact from metal is present. 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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Section: Discussion Of Imaging Modalities By Variantmentioning

confidence: 99%

Section: Overview Of Imaging Modalitiesmentioning

confidence: 99%

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

Beaman

Herrmann

Kransdorf

et al. 2017

Journal of the American College of Radiology

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“…For diabetic foot OM, bone scans have a sensitivity of 80Á90% but a specificity of less than 50% (25Á27). The poor specificity relates to inability of the bone scan to distinguish OM from other inflammatory or traumatic conditions involving the bone, such as Charcot neuroarthropathy joint disease, bone metastasis, gout, fracture, or even recent surgery (28,29). It must also be noted that it is difficult to delineate the exact anatomical location or extent of infection with a bone scan (Fig.…”

Section: Bone Scintigraphymentioning

confidence: 99%

Osteomyelitis in Diabetic Foot

Nather¹,

Cheong²,

Malhortra³

et al. 2016

Surgery for Diabetic Foot

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Osteomyelitis (OM) is a common complication of diabetic foot ulcers and/or diabetic foot infections. This review article discusses the clinical presentation, diagnosis, and treatment of OM in the diabetic foot. Clinical features that point to the possibility of OM include the presence of exposed bone in the depth of a diabetic foot ulcer. Medical imaging studies include plain radiographs, magnetic resonance imaging, and bone scintigraphy. A high index of suspicion is also required to make the diagnosis of OM in the diabetic foot combined with clinical and radiological studies.

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“…For diabetic foot OM, bone scans have a sensitivity of 80–90% but a specificity of less than 50% (25–27). The poor specificity relates to inability of the bone scan to distinguish OM from other inflammatory or traumatic conditions involving the bone, such as Charcot neuroarthropathy joint disease, bone metastasis, gout, fracture, or even recent surgery (28, 29). It must also be noted that it is difficult to delineate the exact anatomical location or extent of infection with a bone scan (Fig.…”

Section: Medical Imaging For Om In the Diabetic Footmentioning

confidence: 99%