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Old 05-21-2012
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Question Osteomyelitis Dx..MRI or bone scan?

I am finding sources with conflicting information. Kaplan says bone scan..but medscape says that MRI is now used for early detection of osteomyelitis and is the test of choice.

http://emedicine.medscape.com/articl...0-workup#a0720

Can anyone shed light on what the Test of choice is for ck?
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If we go with the MRI option over the Bone scan..... Then say the pt comes in after 2 weeks....
Correct me if I am wrong...for the best initial tests
Pt presents ...
Before 2 weeks .... Then go for MRI for early detection.. If you need alternative for MRI...do bone scan.
After 2 weeks.... Then we do an X-ray instead of MRI since time passed will allow us to see changes on X-ray.

This is my understanding of best initial for osteomyelitis ..please correct me if I am wrong in any of this.
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Well what I read in the Kaplan Qbank is:
MRI is the best (initial and accurate) test.
Bone scan is done if there are metal impants such as K-wire etc.
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Quote:
Originally Posted by iceman_purav View Post
Well what I read in the Kaplan Qbank is:
MRI is the best (initial and accurate) test.
Bone scan is done if there are metal impants such as K-wire etc.
But how about when the patient presents after two weeks? Would an x-ray be sufficient to make the diagnosis after two weeks or must we still go with MRI as the best initial test during this time?
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Originally Posted by usmledee View Post
But how about when the patient presents after two weeks? Would an x-ray be sufficient to make the diagnosis after two weeks or must we still go with MRI as the best initial test during this time?
X-rays and CT scan have no role in Osteomyelitis (acc to Kaplan Qbank explanation). Hence no matter what we always choose MRI.
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Well, in case of osteomyelitis... the best initial should always be x-ray. However,most accurate is ' biopsy '. If x-ray is normal then next step is to go for MRI. Now about ' Bone Scan '... bone scan will be the choice if MRI is contraindicated such as pacemaker
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Quote:
Originally Posted by dryogi View Post
Well, in case of osteomyelitis... the best initial should always be x-ray. However,most accurate is ' biopsy '. If x-ray is normal then next step is to go for MRI. Now about ' Bone Scan '... bone scan will be the choice if MRI is contraindicated such as pacemaker
Again I'm going to bring up to two weeks issue, if you look in the Kaplan surgery 2008 2009 edition page 108 it mentions to not fall for the x-ray choice as an answer, and specifically mentions that x-ray will not show anything in the first two weeks. So if this is the case and the patient presents to you after two weeks then MRI would probably be the best initial test instead of an x-RAY. however you mention above that the best initial test should always be X-ray. Can you provide your source? thank you
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