Osteomyelitis of the thoracic spine demonstrated on a sagittal, fatsuppressed T1-weighted magnetic resonance image after the administration of IV gadolinium. At T8–T9, there is involvement of the adjacent vertebral bodies and intervening disk. Abnormally enhancing inflammatory tissue extends from the disk space anteriorly (white arrow) as well as posteriorly into the epidural space, compressing the thecal sac (black arrow). The role of diagnostic imaging in chronic osteomyelitis is to detect active infection and delineate the extent of debridement necessary to remove necrotic bone and abnormal soft tissues. CT is more sensitive than plain films for the detection of sequestra, sinus. | Chapter 120. Osteomyelitis Part 4 Figure 120-1 Source Fauci AS Kasper DL Braunwald E Hauser SL Longo DL Jameson JL Loscalzo J Harrison s Principles of Interna Medicine 17th Edition http Copyright The McGraw-Hill Companies Inc. All rights reserved. Osteomyelitis of the thoracic spine demonstrated on a sagittal fat-suppressed T1-weighted magnetic resonance image after the administration of IV gadolinium. At T8-T9 there is involvement of the adjacent vertebral bodies and intervening disk. Abnormally enhancing inflammatory tissue extends from the disk space anteriorly white arrow as well as posteriorly into the epidural space compressing the thecal sac black arrow . The role of diagnostic imaging in chronic osteomyelitis is to detect active infection and delineate the extent of debridement necessary to remove necrotic bone and abnormal soft tissues. CT is more sensitive than plain films for the detection of sequestra sinus tracts and soft tissue abscesses. Both CT and ultrasound are useful for guiding percutaneous aspiration of subperiosteal and soft tissue fluid collections. Sequential technetium and gallium or indium scans may help determine whether infection is active and may distinguish infection from noninflammatory bone changes. MRI provides superior information about the anatomic extent of infection but does not always distinguish osteomyelitis from healing fractures and tumors. MRI is particularly useful in distinguishing cellulitis from osteomyelitis in the diabetic foot however no imaging modality consistently distinguishes infection from neuropathic osteopathy. Appropriate samples for microbiologic studies should be obtained in all cases of suspected osteomyelitis before the initiation of antimicrobial therapy. Blood cultures are indicated in acute cases and are positive in more than one-third of cases of hematogenous osteomyelitis in children and 25 of cases of vertebral osteomyelitis in adults. The presence of sepsis occasionally .
