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Osteomyelitis Bone Scan

Aka: Osteomyelitis Bone Scan, Osteomyelitis Bone Scan with Technetium-99m Methylene Diphosphonate, Osteomyelitis Bone Scan with Labeled White Cells, Osteomyelitis Bone Scan with Gallium-67 Citrate, Bone Scan in Suspected Osteomyelitis
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  1. Indications
    1. Distinguish Osteomyelitis from Cellulitis
    2. Osteomyelitis MRI contraindicated (e.g. due to Pacemaker)
      1. In combination with Leokocyte Scintigraphy, efficacy approaches that of MRI
      2. However does not define anatomy as seen with Osteomyelitis MRI
  2. Differential Diagnosis: Osteomyelitis on bone scan
    1. Soft Tissue infection
    2. Neurotrophic lesion
    3. Gouty Arthritis
    4. Degenerative Joint Disease
    5. Postsurgical change
    6. Charcot's Foot
    7. Healing Fracture or Stress Fracture
    8. Noninfectious Inflammation
  3. Findings
    1. Increased blood flow and blood pool activity
    2. Positive uptake on 3 hour images
  4. Efficacy: Standard Bone Scan
    1. Technetium-99m Methylene Diphosphonate Bone Scan
      1. Test Sensitivity: 86%
      2. Test Specificity: 45%
  5. Efficacy: Tests done in combination with standard bone scan to increase efficacy
    1. Technetium-99m Hexamethyl-propyleneamine Oxime-labeled White Blood Cell Scan
      1. Test Sensitivity: 90% in Diabetic Foot Osteomyelitis
      2. Test Specificity: 80-90% in Diabetic Foot Osteomyelitis
    2. Indium-111-labeled Leukocyte scanning
      1. Test Sensitivity: 89%
      2. Test Specificity: 79%
    3. Gallium-67 Citrate Scan
      1. Test Sensitivity: 25-80% in Diabetic Foot Osteomyelitis
      2. Test Specificity: 67-85% in Diabetic Foot Osteomyelitis
  6. Advantages
    1. Abnormal uptake seen 2 weeks before Osteomyelitis XRay changes
    2. Osteomyelitis findings present within 48 hours of symptom onset
  7. Disadvantages
    1. Low Test Specificity in standard bone scan (can not distinguish Osteomyelitis from trauma or recent post-surgical changes)
  8. References
    1. Pineda (2006) Infect Dis Clin North Am 20:789-825
    2. Termaat (2005) J Bone Joint Surg Am 87: 2464-71

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