Pediatric Osteomyelitis: A Scintigraphic Review

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:

Nuclear Medicine Technology: 2.50
Procedures: 2.50
Other Imaging Procedures: 2.50

Registered Radiologist Assistant: 2.50
Procedures: 2.50
Musculoskeletal and Endocrine Sections: 2.50

Outline

1. Introduction
2. Imaging Modalities
3. Scintigraphic Protocol
4. Special Pediatric Considerations
5. Pathophysiology
6. Neonates
7. Differential Diagnosis
8. Conclusions

Objectives

Upon completion of this course, students will:

1. identify the most common source for osteomyelitis
2. be familiar with the routes of infection for osteomyelitis
3. identify the most common route of infection for osteomyelitis
4. be familiar with the first imaging assessment performed for osteomyelitis
5. identify which imaging modality is more suited for soft-tissue changes associated with osteomyelitis
6. understand the advantages of MRI for osteomyelitis
7. identify the imaging modalities that are not used for screening osteomyelitis
8. understand the advantages of using bone scintigraphy for osteomyelitis
9. be familiar with the time frame for osteomyelitis to appear on bone scintigraphy
10. understand when to use MRI as the imaging modality for suspected osteomyelitis
11. identify the goal of treatment for patients suffering from osteomyelitis
12. be familiar with the traditional delivery of antibiotics to treat osteomyelitis
13. identify what radiopharmaceutical is used for bone scintigraphy
14. be familiar with the first phase of the triple-phase bone scintigraphy
15. recognize which phase of triple-phase bone scintigraphy is definitive
16. understand the role of whole-body imaging for osteomyelitis
17. be familiar with the radiopharmaceutical uptake of diphosphonates
18. understand the role of white blood cell scintigraphy
19. be familiar with hydroxyapatite crystals
20. understand the localization of bone radiopharmaceuticals in the human body
21. be familiar with alternatives to ^99mTc MDP for bone scintigraphy
22. identify what test is used to determine quality control on ^99mTc MDP
23. recognize drugs that can alter biodistribution of bone imaging agents
24. be familiar with radiopharmaceuticals used for PET bone scans
25. be familiar with the dose administration to imaging time for a PET bone scan
26. be familiar with the methods for calculating pediatric radiopharmaceutical doses
27. understand who determines the need for sedation
28. be familiar with the organization that provides guidelines for pediatric sedation
29. be familiar with the organization that exists to minimize pediatric radiation exposure
30. understand how osteomyelitis begins in pediatric patients’ long bones
31. understand why microorganisms may grow in the metaphyseal capillaries
32. be familiar with the characteristics of Brodie abscess
33. identify the most common bacterial pathogenic cause for osteomyelitis
34. be familiar with the clinical signs of osteomyelitis in neonates
35. be familiar with the location of septic arthritis in children younger than 1 year of age