eMedicine Specialties > Radiology > Musculoskeletal
Osteomyelitis, Chronic: Follow-up
Updated: Feb 10, 2009
Intervention
White and associates examined 25 patients with suspected osteomyelitis to determine the utility of combined histologic and microbiologic evaluation of percutaneous biopsy samples.42 Biopsy samples were obtained with usual trephine techniques under radiologic guidance. Core and aspiration biopsy samples were obtained for both histologic and microbiologic analyses.
Sixteen biopsy specimens demonstrated histologic evidence of osteomyelitis. Of these, 8 also had positive cultures. Seven of the 8 culture-negative, histologically positive cases were interpreted as chronic osteomyelitis. In no patient were cultures positive and histologic findings negative. Three of 19 patients with proved osteomyelitis had negative histologic and microbiologic findings.
The sensitivity of culture in the diagnosis of osteomyelitis in this study was 42%. The sensitivity of both culture and histologic findings was 84%. The authors concluded that, although the volume of a biopsy specimen was a major determinant of culture yield, a portion of a percutaneous biopsy sample should be histologically evaluated for possible osteomyelitis.
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References
Carek PJ, Dickerson LM, Sack JL. Diagnosis and management of osteomyelitis. Am Fam Physician. Jun 15 2001;63(12):2413-20. [Medline].
Hurtado-Nedelec M, Chollet-Martin S, Nicaise-Roland P, Grootenboer-Mignot S, Ruimy R, Meyer O, et al. Characterization of the immune response in the synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) syndrome. Rheumatology (Oxford). Jun 17 2008;[Medline].
Vavrík P, Jaroová K, Popelka S, Bek1 J. SAPHO Syndrome - Rare Case of Joint Damage Treated By Knee Synovectomy and Total Hip Joint Replacement. Acta Chir Orthop Traumatol Cech. 2008;75(3):221-225. [Medline].
Alazraki NP. Radionuclide imaging in the evaluation of infections and inflammatory disease. Radiol Clin North Am. Jul 1993;31(4):783-94. [Medline].
Demharter J, Bohndorf K, Michl W, Vogt H. Chronic recurrent multifocal osteomyelitis: a radiological and clinical investigation of five cases. Skeletal Radiol. Oct 1997;26(10):579-88. [Medline].
Gold R. Radiographic diagnosis of osteomyelitis. Pediatr Infect Dis J. Jun 1995;14(6):555. [Medline].
Gold RH, Tong DJ, Crim JR, Seeger LL. Imaging the diabetic foot. Skeletal Radiol. Nov 1995;24(8):563-71. [Medline].
Jurriaans E, Singh NP, Finlay K, Friedman L. Imaging of chronic recurrent multifocal osteomyelitis. Radiol Clin North Am. Mar 2001;39(2):305-27. [Medline].
Kaim AH, Gross T, von Schulthess GK. Imaging of chronic posttraumatic osteomyelitis. Eur Radiol. May 2002;12(5):1193-202. [Medline].
Lobo J, McKee M. Musculoskeletal images. Chronic osteomyelitis. Can J Surg. Feb 2003;46(1):47-9. [Medline].
Tehranzadeh J, Wong E, Wang F, Sadighpour M. Imaging of osteomyelitis in the mature skeleton. Radiol Clin North Am. Mar 2001;39(2):223-50. [Medline].
Wiest PW, Hartshorne MF. Chronic osteomyelitis: clarification of nuclear medicine findings by fusion scans. Clin Nucl Med. Mar 2001;26(3):233-6. [Medline].
Yang DC, Ratani RS, Mittal PK, et al. Radionuclide three-phase whole-body bone imaging. Clin Nucl Med. Jun 2002;27(6):419-26. [Medline].
de Winter F, van de Wiele C, Vogelaers D, et al. Fluorine-18 fluorodeoxyglucose-position emission tomography: a highly accurate imaging modality for the diagnosis of chronic musculoskeletal infections. J Bone Joint Surg Am. May 2001;83-A(5):651-60. [Medline].
De Winter F, Vogelaers D, Gemmel F, Dierckx RA. Promising role of 18-F-fluoro-D-deoxyglucose positron emission tomography in clinical infectious diseases. Eur J Clin Microbiol Infect Dis. Apr 2002;21(4):247-57. [Medline].
Guhlmann A, Brecht-Krauss D, Suger G, et al. Chronic osteomyelitis: detection with FDG PET and correlation with histopathologic findings. Radiology. Mar 1998;206(3):749-54. [Medline].
Tehranzadeh J, Wong E, Wang F, Sadighpour M. Imaging of osteomyelitis in the mature skeleton. Radiol Clin North Am. Mar 2001;39(2):223-50. [Medline].
Zhuang H, Alavi A. 18-fluorodeoxyglucose positron emission tomographic imaging in the detection and monitoring of infection and inflammation. Semin Nucl Med. Jan 2002;32(1):47-59. [Medline].
Lopes TD, Reinus WR, Wilson AJ. Quantitative analysis of the plain radiographic appearance of Brodie''s abscess. Invest Radiol. Jan 1997;32(1):51-8. [Medline].
Madsen JL. Bone SPECT/CT detection of a sequestrum in chronic-infected nonunion of the tibia. Clin Nucl Med. Oct 2008;33(10):700-1. [Medline].
Strobel K, Stumpe KD. PET/CT in musculoskeletal infection. Semin Musculoskelet Radiol. Dec 2007;11(4):353-64. [Medline].
Tanaka R, Hayashi T. Computed tomography findings of chronic osteomyelitis involving the mandible: correlation to histopathological findings. Dentomaxillofac Radiol. Feb 2008;37(2):94-103. [Medline].
Darge K, Jaramillo D, Siegel MJ. Whole-body MRI in children: Current status and future applications. Eur J Radiol. Nov 2008;68(2):289-98. [Medline].
Kattapuram TM, Treat ME, Kattapuram SV. Magnetic resonance imaging of bone and soft tissue infections. Curr Clin Top Infect Dis. 2001;21:190-226. [Medline].
Kruskal JB. Can USPIO-enhanced spinal MR imaging help distinguish acute infectious osteomyelitis from chronic infectious and inflammatory processes?. Radiology. Jul 2008;248(1):1-3. [Medline].
Ledermann HP, Kaim A, Bongartz G, Steinbrich W. Pitfalls and limitations of magnetic resonance imaging in chronic posttraumatic osteomyelitis. Eur Radiol. 2000;10(11):1815-23. [Medline].
Schwegler B, Stumpe KD, Weishaupt D, Strobel K, Spinas GA, von Schulthess GK, et al. Unsuspected osteomyelitis is frequent in persistent diabetic foot ulcer and better diagnosed by MRI than by 18F-FDG PET or 99mTc-MOAB. J Intern Med. Jan 2008;263(1):99-106. [Medline].
Tehranzadeh J, Wang F, Mesgarzadeh M. Magnetic resonance imaging of osteomyelitis. Crit Rev Diagn Imaging. 1992;33(6):495-534. [Medline].
Cleveland TJ, Peck RJ. Case report: chronic osteomyelitis demonstrated by high resolution ultrasonography. Clin Radiol. Jun 1994;49(6):429-31. [Medline].
Harvey J, Cohen MM. Technetium-99-labeled leukocytes in diagnosing diabetic osteomyelitis in the foot. J Foot Ankle Surg. May-Jun 1997;36(3):209-14; discussion 256. [Medline].
Ivancevic V, Dodig D, Livakovic M, et al. Comparison of three-phase bone scan, three-phase 99m-Tc-HM-PAO leukocyte scan and 67-gallium scan in chronic bone infection. Prog Clin Biol Res. 1990;355:189-98. [Medline].
Rachinsky I, Agranovich S, Lantsberg S. Imaging of bone to skin sinus tract from osteomyelitis of the femur by Tc-99m HMPAO leukocyte scintigraphy. Clin Nucl Med. Dec 2002;27(12):891-2. [Medline].
Wolf G, Aigner RM, Schwarz T. Diagnosis of bone infection using 99m Tc-HMPAO labelled leukocytes. Nucl Med Commun. Nov 2001;22(11):1201-6. [Medline].
Palestro CJ. The current role of gallium imaging in infection. Semin Nucl Med. Apr 1994;24(2):128-41. [Medline].
Stokkel MP, Takes RP, van Eck-Smit BL, et al. The value of quantitative gallium-67 single-photon emission tomography in the clinical management of malignant external otitis. Eur J Nucl Med. Nov 1997;24(11):1429-32. [Medline].
Schauwecker DS. Osteomyelitis: diagnosis with In-111-labeled leukocytes. Radiology. Apr 1989;171(1):141-6. [Medline].
Meller J, Koster G, Liersch T, et al. Chronic bacterial osteomyelitis: prospective comparison of (18)F-FDG imaging with a dual-head coincidence camera and (111)In-labelled autologous leucocyte scintigraphy. Eur J Nucl Med Mol Imaging. Jan 2002;29(1):53-60. [Medline].
Palestro CJ, Mehta HH, Patel M, et al. Marrow versus infection in the Charcot joint: indium-111 leukocyte and technetium-99m sulfur colloid scintigraphy. J Nucl Med. Feb 1998;39(2):346-50. [Medline].
Lichtenstein M, Andrews J, Scales R. Localization of osteomyelitis with 99mtechnetium sulphur colloid. Aust N Z J Surg. Aug 1983;53(4):339-42. [Medline].
Zhuang H, Duarte PS, Pourdehand M, et al. Exclusion of chronic osteomyelitis with F-18 fluorodeoxyglucose positron emission tomographic imaging. Clin Nucl Med. Apr 2000;25(4):281-4. [Medline].
Datz FL. Indium-111-labeled leukocytes for the detection of infection: current status. Semin Nucl Med. Apr 1994;24(2):92-109. [Medline].
White LM, Schweitzer ME, Deely DM, Gannon F. Study of osteomyelitis: utility of combined histologic and microbiologic evaluation of percutaneous biopsy samples. Radiology. Dec 1995;197(3):840-2. [Medline].
Jacobson AF, Gilles CP, Cerqueira MD. Photopenic defects in marrow-containing skeleton on indium-111 leucocyte scintigraphy: prevalence at sites suspected of osteomyelitis and as an incidental finding. Eur J Nucl Med. 1992;19(10):858-64. [Medline].
Kak V, Chandrasekar PH. Bone and joint infections in injection drug users. Infect Dis Clin North Am. Sep 2002;16(3):681-95. [Medline].
Oyen WJ, van Horn JR, Claessens RA, et al. Diagnosis of bone, joint, and joint prosthesis infections with In-111- labeled nonspecific human immunoglobulin G scintigraphy. Radiology. Jan 1992;182(1):195-9. [Medline].
Sato T, Indo H, Kawabata Y, et al. Scintigraphic evaluation of chronic osteomyelitis of the mandible in SAPHO syndrome. Dentomaxillofac Radiol. Sep 2001;30(5):293-5. [Medline].
Further Reading
Keywords
chronic osteomyelitis, bone infection, bone marrow infection, acute osteomyelitis, subacute osteomyelitis, Garrès sclerosing osteomyelitis, Brodie abscess, tuberculous osteomyelitis, congenital syphilis, acquired syphilis, periosteitis, metaphysitis, sabre tibia
Follow-up: Osteomyelitis, Chronic