Imaging of Osteomyelitis in Children

Infection of the pediatric musculoskeletal system still constitutes a diagnostic and therapeutic challenge. 26 Antibiotic therapy has a high success rate in most bacterial infections. Key elements are the route of administration of the antibiotics and the duration of treatment. Diagnostic imaging accuracy has improved with the proper use of guidelines in the choice of the emerging modalities. 11,27,37 Osteomyelitis, however, is a multifaceted disease, according to the age of the patient, site of infection, and the type of clinical setting (immunosuppressed patient, sickle cell disease, and so forth). Diagnostic pitfalls are occasionally encountered and often leukemia or neuroblastoma may mimic osteomyelitis. An early diagnosis of skeletal infection is important, otherwise sequelae may result. 6 With the advent of scintigraphy, sonography, CT, and MR imaging, the imaging approach to osteomyelitis is not simple but the results are more accurate. Factors, such as the need for sedation, radiation exposure, and cost, cannot be dismissed. Selection of the optimal technique is essential for obtaining the diagnostic information needed. Following a brief review of the physiopathology of osteomyelitis, the different imaging modalities are presented with a focus on their potential values. The classical presentations, and some more specific clinical scenarios, are described along with considerations of differential diagnosis.