- chronic sclerosing osteomyelitis (of Garre) has dense sclerotic appearance and often no associated lucency on radiographs;
- lesion usually involves the entire circumference of the bone and is much more widespread than a stress fracture;
- thinner linear sclerotic appearance of a stress fracture
should be characteristic enough to distinguish the two lesions;
- serial radiographs generally show little or no change within a short time in sclerosing osteomyelitis;
- typical stress fracture, however, has a rapidly evolving course over several weeks;
- Radiographic Findings:
- fluorine-18 fluorodeoxyglucose-positron emission tomography:
- FFPET is an accurate imaging technique which is more accurate than combination of a bone scan and a WBC scan for the dx of chronic infection of the spine;
- in the report by de Winter F, et al
, the authors evaluated the value of fluorine-18 fluorodeoxyglucose-positron emission tomography in the diagnosis of osteomyelitis;
- 60 patients with a suspected chronic musculoskeletal infection involving the central skeleton (33 patients) or the peripheral skeleton (27 patients) were studied;
- 35 patients had had surgery within the previous two years;
- 25 patients had infection and thirty-five did not - all 25 infections were correctly identified by both readers;
- 4 false-positive findings; in two of these cases, surgery had been performed less than 6 months prior to the study;
- sensitivity, specificity, and accuracy were 100%, 88%, and 93% for the whole group;
- 100%, 90%, and 94% for the subgroup of patients with a suspected infection of the central skeleton; and 100%, 86%, and 93% for the subgroup of patients with a suspected infection of the peripheral skeleton;
- ref: Fluorine-18 fluorodeoxyglucose-position emission tomography: a highly accurate imaging modality for the diagnosis of chronic musculoskeletal infections.
- Debridement of Sequestra
- Antibiotics Cement Beads
Images in clinical medicine. Bone within bone--chronic osteomyelitis.
Original Text by Clifford R. Wheeless, III, MD.