Start With Radiographs When Suspecting Musculoskeletal Infection

Radiographs are recommended initial imaging examination for patients presenting with possible infection of the musculoskeletal system, according to an article published in the Journal of the American College of Radiology.  According to a multidisciplinary expert panel reviewing guidelines from the American College of Radiology Appropriateness Criteria, although radiographs may not be diagnostic in acute osteomyelitis, they can provide anatomic evaluation and alternative diagnoses influencing subsequent imaging selection and interpretation. MRI with contrast is the examination of choice for the evaluation of suspected osteomyelitis, and MRI, CT, and ultrasound can all be useful in the diagnosis of soft tissue infection. CT or a labeled leukocyte scan and sulfur colloid marrow scan combination are alternative options if MRI is contraindicated or extensive artifact from metal is present. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.