II. Indications
- Distinguish Osteomyelitis from Cellulitis
-
Osteomyelitis MRI contraindicated (e.g. due to Pacemaker)
- In combination with Leokocyte Scintigraphy, efficacy approaches that of MRI
- However does not define anatomy as seen with Osteomyelitis MRI
III. Differential Diagnosis: Osteomyelitis on bone scan
- Soft Tissue infection
- Neurotrophic lesion
- Gouty Arthritis
- Degenerative Joint Disease
- Postsurgical change
- Charcot's Foot
- Healing Fracture or Stress Fracture
- Noninfectious Inflammation
IV. Findings
- Increased Blood Flow and blood pool activity
- Positive uptake on 3 hour images
V. Efficacy: Standard Bone Scan
- Technetium-99m Methylene Diphosphonate Bone Scan
- Test Sensitivity: 86%
- Test Specificity: 45%
VI. Efficacy: Tests done in combination with standard bone scan to increase efficacy
- Technetium-99m Hexamethyl-propyleneamine Oxime-labeled White Blood Cell Scan
- Indium-111-labeled Leukocyte scanning
- Test Sensitivity: 89%
- Test Specificity: 79%
- Gallium-67 Citrate Scan
- Test Sensitivity: 25-80% in Diabetic Foot Osteomyelitis
- Test Specificity: 67-85% in Diabetic Foot Osteomyelitis
VII. Advantages
- Abnormal uptake seen 2 weeks before Osteomyelitis XRay changes
- Osteomyelitis findings present within 48 hours of symptom onset
VIII. Disadvantages
- Low Test Specificity in standard bone scan (can not distinguish Osteomyelitis from Trauma or recent post-surgical changes)