Bone scan or xray?

[lsu1000]

In a patient that presents with obvious, or somewhat obvious osteomyelitis...which test should be done 1st? Bone Scan or Xray?

It seems like most of the time, you should just xray something first(ie cheap, fast), but in this case bone scan seems more accurate.

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[Bevo]

osteomyelitis won't show on an xray till they've had osteomyelitis for a few weeks.

MRI is the best test, bone scan is 2nd.

 

[Idiopathic]

In early osteo, the most advanced test offered is usually the answer.

 

[lsu1000]

UW says MRI is only used for spinal osteomyelitis and that bone scan is the test of choice after xray.

I did a search, and most articles say bone scan is the best initial test, and you usually don't need MRI.

I don't know. I guess I'll choose bone scan if they ask what to do next after the xray shows nothing.

 

[poloace]

yeah-
the reason why you do a bonescan rather than an xray is that an xray will show you the surface anatomy which is likely to be unchanged in osteomyelitis. however, in osteomyelitis you have increased bone activity which acts as a 'hotspot' for the radioactive tracer to bind to. so, you'll see increased activity where the infection is - something that cannot be delinieated on plain film. definitely choose this over plain film.

p

 

[Bevo]

Well, at kaplan they said to do the MRI.

which is why I said what I did. Personally, I would hate to have to choose between an MRI and bone scan.

I dunno if its ok to post this excerpt from uptodate.

"SUMMARY — The diagnostic test of choice for osteomyelitis varies with the clinical setting. In uncomplicated cases of suspected acute osteomyelitis, plain films are fairly specific but insensitive for osteomyelitis. If plain films are negative, a three phase technetium bone scan is the test of choice. Plain films should also be obtained in chronic osteomyelitis to aid in interpreting other studies.

In suspected cases of complicated osteomyelitis (eg, complicating a fracture, postoperative state, neuropathy, vasculopathy), the options are a little more varied:

A nuclear study may be the test of choice when there is hardware in place, which would seriously degrade the images on MRI or CT. If a nuclear study is chosen, the test of choice would be either an indium scan or a dual tracer examination, combining indium labeled white cells with three phase bone scan (in the hands and feet) or bone marrow scan (in the axial skeleton) [22,23]. Acute infections image better than chronic infections due to the briskness of the inflammatory response.
MRI is the test of choice in evaluating the spine for osteomyelitis, since it provides the anatomic detail necessary to rule out potential neurologic complications and abscesses. The diabetic foot ulcer has such a high risk of having underlying osteomyelitis if the ulcer is larger than 2 cm x 2 cm or bone is palpable that further noninvasive testing is not warranted to rule in osteomyelitis. If neither of these clinical findings is present, an MRI may be useful in evaluating for osteomyelitis and determining the likely extent of debridement (See "Management of diabetic foot infections"). "

If it needs to be removed, then I'll remove it.

UptoDate coincides with what others have said.

 

[Idiopathic]

Id always do bone scan over xray if listed, but if MRI was there, I think Id do it above all else.

 

[njbmd]

In a patient that presents with obvious, or somewhat obvious osteomyelitis...which test should be done 1st? Bone Scan or Xray?

It seems like most of the time, you should just xray something first(ie cheap, fast), but in this case bone scan seems more accurate.

Hi there,
Be sure to read the scenario. The most sensitive and specific test for osteomyelitis is MRI but every patient is not a candidate for MRI. In that case, bone scan would be the next most sensitive. Plain radiographs can diagnose osteomyelitis but it has to have been there long enough for radiological changes to be picked up.

If I am trying to make the diagnosis, I am using MRI if I can.

njbmd

 

[Diana_UC]

Hi there,
Be sure to read the scenario. The most sensitive and specific test for osteomyelitis is MRI but every patient is not a candidate for MRI. In that case, bone scan would be the next most sensitive. Plain radiographs can diagnose osteomyelitis but it has to have been there long enough for radiological changes to be picked up.

If I am trying to make the diagnosis, I am using MRI if I can.

njbmd

Yea, exactly... njbmd sums it up nice. The patient you are going to need to get Bone Scans in over MRI's are the patients that can't get an MRI, because they have hardware or something.

 

[Idiopathic]

Now this I dont know about. Most all hardware done nowadays can go in an MRI, so someone who had a knee done 25 years ago or who has a big piece of mesh stapled in might not be able to get an MRI, but someone who had a knee replacement in 2001 can get an MRI, so Im not sure theyd ask you to distinguish between the two. They are more likely to want to test whether you understand that XR is not a good first line test for acute osteo. I doubt theyd make you choose between bone scan and MRI.