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Osteomyelitis is an increasingly common pathology that often poses a diagnostic challenge to clinicians. Accurate and timely diagnosis is critical to prevent complications that can result in the loss of life or limb. In addition to history, physical exam, and laboratory studies, diagnostic imaging plays an essential role in the diagnostic process. This narrative review article discusses various imaging modalities employed to diagnose , namely plain films, computed tomography (CT), magnetic resonance imaging (MRI), ultrasound, bone scintigraphy, and positron emission tomography (PET). Articles were obtained from PubMed and screened for relevance to the topic of diagnostic imaging for osteomyelitis. The authors conclude that plain films are an appropriate first step as they may reveal osteolytic changes and can help rule out alternative pathology. MRI is often the most appropriate second study, as it is highly sensitive and can detect bone marrow changes within days of an infection. Other studies such as CT, ultrasound, and bone scintigraphy may be useful in patients who cannot undergo MRI. CT is useful for identifying necrotic bones in chronic infections. Ultrasound may be useful in children or with sickle-cell disease. Bone scintigraphy is particularly useful for vertebral osteomyelitis. Finally, PET has demonstrated high sensitivity and specificity; however, its clinical application is limited by its high cost and poor availability. When used appropriately, diagnostic imaging can provide high sensitivity and specificity for detecting osteomyelitis, making radiographic evaluation a crucial step in the diagnostic process of this debilitating condition.

Osteomyelitis is an increasingly common condition that possesses a diagnostic challenge to the clinicians. Accurate and timely diagnosis is crucial for preventing complications that can result in the loss of life or limb. In addition to history, physical examination, and laboratory studies, diagnostic imaging is essential in the diagnostic process. In this narrative review article, various imaging modalities to diagnose osteomyelitis are described; these includeplain radiography, computed tomography (CT), magnetic resonance imaging (MRI), ultrasonography, bone scintigraphy, and positron emission tomography (PET). Articles were identified through PubMed and screened for relevance to the topic of diagnostic imaging for osteomyelitis. The authors concluded that plain radiography is an appropriate first step because the images may reveal osteolytic changes and can help rule out alternative disease. MRI is often the most appropriate second step because it is highly sensitive and can reveal bone marrow changes within days of an infection. Other imaging modalities such as CT, ultrasonography, and bone scintigraphy may be useful for patients in who MRI cannot be performed. CT is useful for identifying necrotic bone in chronic infections. Ultrasonography may be useful in children or individuals with sickle-cell disease. Bone scintigraphy is particularly useful in detecting vertebral osteomyelitis. Finally, PET has demonstrated high sensitivity and specificity; however, as it is expensive and often unavailable its clinical application is limited. When used appropriately, radiographic evaluation has high sensitivity and specificity for detecting osteomyelitis; thus, it is a crucial step in diagnosing this debilitating condition.

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