Version July 2025
CT: computed tomography; IV: intravenous; MRI: magnetic resonance imaging; SPECT: single-photon emission computed tomography.
* Conventional radiographs (ie, plain x-rays) have low sensitivity in patients in the first 1 to 2 weeks of symptoms.
¶ MRI may be contraindicated in patients who have certain types of metallic foreign bodies anywhere in their body.
Δ Visualizing soft tissue infection can be important to identify a suspected abscess and/or to guide percutaneous drainage or surgical debridement.
◊ In patients with kidney dysfunction, some clinicians avoid IV gadolinium due to the possibility of nephrogenic systemic fibrosis. Refer to UpToDate content for details.
§ For CTs, IV contrast is not necessary for detection of osteomyelitis but improves visualization of soft tissue infection. Use of IV contrast for CTs increases risk of acute kidney injury, especially in patients with other risk factors; refer to UpToDate content for details.
¥ Scintigraphy refers to two-dimensional nuclear imaging studies, such as three-phase bone scan, tagged white blood cell scan, and gallium scan. MRI and CT are generally favored over scintigraphy, but scintigraphy may be helpful in patients with metal hardware that contraindicates or obscures MRI or CT. For information about each study, refer to UpToDate's topic on imaging studies for osteomyelitis.