Osteomyelitis Imaging: An Updated Overview for Radiologists

Abstract

Background: Osteomyelitis is a complex inflammatory disease of the bone and bone marrow, primarily caused by bacterial infections. It can result from hematogenous spread, direct inoculation, or contiguous spread from nearby infected tissues. The disease manifests in acute, subacute, and chronic forms, each with distinct clinical presentations and complications. Accurate diagnosis and management are critical to prevent severe outcomes such as bone destruction, systemic infection, and chronic pain. Imaging plays a pivotal role in the early detection and assessment of osteomyelitis, guiding both medical and surgical interventions.

Aim: This article aims to provide an updated overview of imaging modalities used in the diagnosis and management of osteomyelitis, highlighting their strengths, limitations, and clinical applications. It emphasizes the importance of integrating advanced imaging techniques with clinical evaluation to improve diagnostic accuracy and patient outcomes.

Methods: The review discusses various imaging techniques, including plain radiography, computed tomography (CT), magnetic resonance imaging (MRI), ultrasonography (US), and nuclear medicine studies such as bone scintigraphy, gallium scanning, and 18F-FDG PET-CT. Each modality's role in detecting early and chronic osteomyelitis, assessing complications, and guiding treatment is evaluated. The article also explores the anatomical and pathophysiological basis of osteomyelitis, focusing on how imaging can visualize bone and soft tissue changes.

Results: Plain radiography, while useful for initial evaluation, often fails to detect early osteomyelitis. MRI is the most sensitive modality for early detection, particularly in identifying bone marrow edema and soft tissue involvement. CT is valuable for assessing bony destruction and chronic changes, while US is beneficial in pediatric cases and for guiding interventions. Nuclear medicine techniques, such as bone scintigraphy and 18F-FDG PET-CT, offer high sensitivity and specificity, especially in complex or multifocal cases. A combination of these imaging modalities, tailored to the clinical context, enhances diagnostic accuracy and guides effective treatment strategies.

Conclusion: Advanced imaging techniques have revolutionized the diagnosis and management of osteomyelitis. While each modality has its strengths and limitations, their integration into a structured diagnostic approach ensures timely and accurate diagnosis, reducing the risk of complications. Collaboration between clinicians and radiologists is essential for optimizing patient care and improving outcomes in osteomyelitis.