title: Should single-phase radionuclide bone imaging be used in suspected osteomyelitis?
abstract: The records of 69 patients who had 86 delayed, static radionuclide bone images for suspected osteomyelitis were studied to determine the effects of this procedure on diagnosis and treatment. Sensitivity, specificity, and positive predictive value were lower than reported in several other studies. When osteomyelitis was unlikely, imaging was either negative or falsely positive and rarely affected treatment. In 46 cases where osteomyelitis was more likely, imaging potentially changed therapy in 19 but was unhelpful or misleading in 15. One third of the interpretations were "equivocal" and these were incorrect four times more often than "definite" readings. Two false-positive images led to unnecessary surgeries, and one patient with negative images died with unrecognized osteomyelitis. Static-phase images with "definite" interpretations, particularly when negative, are specific, but "equivocal" studies may lead to diagnostic and therapeutic errors. When osteomyelitis is improbable, imaging rarely changes diagnosis or therapy.
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001842:Bone and Bones / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000000981:diagnostic imaging*; D011877:Radionuclide Imaging