II. 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

III. 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

IV. Findings

  1. Increased blood flow and blood pool activity
  2. Positive uptake on 3 hour images

V. Efficacy: Standard Bone Scan

  1. Technetium-99m Methylene Diphosphonate Bone Scan
    1. Test Sensitivity: 86%
    2. Test Specificity: 45%

VI. 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

VII. Advantages

  1. Abnormal uptake seen 2 weeks before Osteomyelitis XRay changes
  2. Osteomyelitis findings present within 48 hours of symptom onset

VIII. Disadvantages

  1. Low Test Specificity in standard bone scan (can not distinguish Osteomyelitis from Trauma or recent post-surgical changes)

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