From the Guidelines
Osteomyelitis is characterized by distinct findings including localized bone pain, tenderness, warmth, and swelling, with MRI being the most sensitive imaging modality for diagnosis, as recommended by the American College of Radiology 1. The characteristic findings of osteomyelitis can be identified through a combination of clinical presentation, laboratory tests, and imaging studies. Patients often present with fever, malaise, and elevated inflammatory markers such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Radiographic findings evolve over time, with early changes including soft tissue swelling and deep soft tissue infection, while later findings show periosteal reaction, bone destruction, and sequestrum (dead bone) formation. Some key points to consider in the diagnosis of osteomyelitis include:
- The role of imaging in diagnosis, with MRI being the most sensitive modality, showing bone marrow edema and abscess formation 1.
- The use of radiographs to outline anatomic detail, evaluate for radiodense foreign bodies or soft-tissue gas, and exclude alternative diagnoses such as fracture, degenerative changes, or tumor 1.
- The utility of CT in depicting cortical bone and diagnosing chronic osteomyelitis, with findings including periosteal reaction, bone destruction, necrotic bone (sequestra), and sinus tracts 1.
- The complementary role of ultrasound (US) in detecting subperiosteal and soft-tissue abscesses, tenosynovitis, joint effusions, and radiolucent foreign bodies 1. The most definitive way to diagnose osteomyelitis is by the combined findings on bone culture and histology, as suggested by the Infectious Diseases Society of America 1.
From the Research
Characteristic Findings of Osteomyelitis
The characteristic findings of osteomyelitis can be identified through various diagnostic modalities, including:
- Imaging studies, such as radiography, magnetic resonance imaging (MRI), and bone scintigraphy 2, 3, 4, 5
- Laboratory results, including serum inflammatory markers and microbial cultures 2, 3, 4
- Clinical presentation, which can vary depending on the location and severity of the infection 2, 3, 4
Diagnostic Imaging
Diagnostic imaging plays a crucial role in supporting a clinical diagnosis of osteomyelitis, with:
- Radiography being the initial imaging procedure, although its sensitivity is low in the early stages of the disease 2, 4, 5
- MRI having a higher sensitivity for detecting areas of bone necrosis in advanced stages, both with and without contrast material 2, 3, 4
- Bone scintigraphy and spiral CT also being useful in diagnosing osteomyelitis, particularly in certain locations such as the sterno-clavicular junction and pelvic bones 5
Laboratory Findings
Laboratory findings, including:
- Microbial cultures, which provide conclusive diagnoses 2, 3, 4
- Serum inflammatory markers, which can support a clinical diagnosis of osteomyelitis 3, 4
- Bone biopsies, which offer definitive diagnosis 2, 4
Clinical Presentation
The clinical presentation of osteomyelitis can vary depending on the location and severity of the infection, with: