Role of Scintigraphy in Musculoskeletal and Spinal Infections

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Musculoskeletal infections are frequently encountered in medical practice. If left untreated, they can cause serious morbidity and mortality. In addition to acute hematogenous osteomyelitis, there are other forms of infection seen in patients with diabetes, following orthopedic procedures for fracture or joint replacement, and in immunosuppressed patients.

Plain radiography remains the mainstay in diagnosing musculoskeletal infections but new diagnostic techniques have emerged in medical imaging: ultrasound, CT, MR imaging, and nuclear medicine (bone scan, gallium, labeled leukocytes, and newer agents). This article reviews the different radiopharmaceuticals used for the diagnosis of soft tissue, joint, and bone infection, and the role of nuclear medicine in the diagnosis of these different pathologies.

Section snippets

RADIOPHARMACEUTICALS

In recent years, a considerable number of radiopharmaceuticals have entered the field of nuclear medicine. From myocardial imaging to neuroendocrine tumor evaluation, they provide new insight into many diseases. The detection of infection and inflammation has not been left behind. In addition to bone agents, gallium, and labeled leukocytes, new exciting substances are being developed and some are already used in clinical practice.

MUSCULOSKELETAL INFECTIONS IN ADULTS

Musculoskeletal infections in adults may have a relatively benign course (e.g., cellulitis) or catastrophic consequences (e.g., in vertebral osteomyelitis complicated by epidural abscess).

MUSCULOSKELETAL INFECTIONS IN CHILDREN

In the pediatric population, untreated musculoskeletal infections can lead to permanent damage to the bone and joint. Nuclear medicine plays an important role in the diagnosis of such infections.

SUMMARY

Clinical findings are still the mainstay for suspecting the diagnosis of musculoskeletal infections, especially osteomyelitis. No single complementary imaging technique has 100% specificity and sensitivity for every case of musculoskeletal infection. Depending on the age of the patient, presence of orthopedic hardware, location of infection, underlying bone, and systemic conditions, the choice of imaging modalities must be tailored to the patient's condition. Plain radiographs are performed

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    Address reprint requests to Sophie Turpin, MD, FRCPC, Nuclear Medicine, Medical Imaging, Montréal Children's Hospital, 2300 Tupper Street, Montréal, QC, H3H 1P3 Canada

    *

    Division of Nuclear Medicine, Department of Medical Imaging, Montréal Children's Hospital; Department of Nuclear Medicine, Hôpital-Ste-Justine; and Department of Nuclear Medicine, CHUM Hôtel-Dieu de Montréal, Montréal, Québec, Canada

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