Several modalities including plain x-ray radiography, ultrasonography, computed tomography (CT), white blood cell (WBC) scans, bone scintigraphy, and magnetic resonance imaging (MRI) are able to help diagnose osteomyelitis. Here are their known sensitivities and specificities, in order of increasing sensitivity:

Plain x-ray radiographs

  • The sensitivity and specificity of plain x-ray radiographs in detecting osteomyelitis vary considerably between studies
  • Plain x-ray radiographs have a sensitivity of about 14% to 54% for detecting osteomyelitis
  • Plain x-ray radiographs have a specificity of about 68% to 96% for detecting osteomyelitis

Ultrasound

  • Ultrasonography has a sensitivity of about 55% for detecting osteomyelitis
  • Ultrasonography has a specificity of about 47% for detecting osteomyelitis

Computed tomography (CT)

  • Computed tomography (CT) scans have a sensitivity of about 67% for detecting osteomyelitis
  • Computed tomography (CT) scans have a specificity of about 50% for detecting osteomyelitis

WBC scans

  • WBC scans have a sensitivity of about 74% for detecting osteomyelitis
  • WBC scans have a specificity of about 68% for detecting osteomyelitis

Bone scintigraphy

  • Bone scintigraphy has a sensitivity of about 81% for detecting osteomyelitis
  • Bone scintigraphy has a specificity of about 28% for detecting osteomyelitis

Magnetic resonance imaging (MRI)

  • Magnetic resonance imaging is currently the most sensitive and specific imaging modality for detecting osteomyelitis
  • Magnetic resonance imaging (MRI) has a sensitivity of about 90% for detecting osteomyelitis—and some studies quote even higher figures
  • Magnetic resonance imaging (MRI) has a specificity of about 79% for detecting osteomyelitis
  • Overall, magnetic resonance imaging (MRI) has an accuracy (weighted average of sensitivity and specificity) of about 89% for detecting osteomyelitis

References

Malcius D, Jonkus M, Kuprionis G, Maleckas A, Monastyreckiene E, Uktveris R, Rinkevicius S, Barauskas V. The accuracy of different imaging techniques in diagnosis of acute hematogenous osteomyelitis. Medicina 45(8):624-631 (2009)

Dinh MT, Abad CL, Safdar N. Diagnostic accuracy of the physical examination and imaging tests for osteomyelitis underlying diabetic foot ulcers: meta-analysis. Clinical Infectious Diseases 47(4):519 (2008)

Butalia S, Palda VA, Sargeant RJ, Detsky AS, Mourad O. Does this patient with diabetes have osteomyelitis of the lower extremity? JAMA 299(7):806 (2008)

Nourse C, Allworth A, Jones A, Horvath R, McCormack J, Bartlett J, Hayes D, Robson JM. Three Cases of Q Fever Osteomyelitis in Children and a Review of the Literature. Clinical Infectious Disease 39(7):e61-e66 (2004)