Zieger B, Elser H, Tröger J
Abteilung Pädiatrische Radiologie, Radiologische Klinik, Klinikum der Ruprecht-Karls-Universität Heidelberg.
Orthopade. 1997 Oct;26(10):820-9. doi: 10.1007/s001320050161.
In acute osteomyelitis of childhood a rapid diagnosis and initiation of antibiotic therapy is necessary in order to prevent late sequelae. Thus, diagnostic imaging plays a crucial role. If acute osteomyelitis is suspected in a child, imaging starts with conventional radiography in order to exclude other differential diagnoses. This is followed by sonography for the purpose of diagnosing a subperiosteal abscess or joint fluid from which the causative organism could be isolated. If the diagnosis is unclear, the next step should be either MRI or 99mTc-MDP bone scan, depending on the possibility of clinical localization and the site of the suspected lesion. MRI is superior to bone scan in depicting the exact anatomy, which is extremely important in spinal osteomyelitis and preoperatively. The bone scan can show the whole skeleton in one examination and should be favored if there is no definite localization or in suspected multifocal osteomyelitis. Rarely scintigraphy with labeled white blood cells is indicated. The 67Ga scan, however, should not be used in children because of the high level of radiation exposure. The different imaging modalities are described in detail and an imaging diagnostic workup is outlined.
在儿童急性骨髓炎中，为预防晚期后遗症，快速诊断并开始抗生素治疗是必要的。因此，诊断性影像学起着关键作用。如果怀疑儿童患有急性骨髓炎，影像学检查首先进行传统X线摄影，以排除其他鉴别诊断。随后进行超声检查，目的是诊断骨膜下脓肿或可从中分离出致病微生物的关节液。如果诊断不明确，下一步应根据临床定位的可能性和疑似病变部位，选择MRI或99mTc-MDP骨扫描。在描绘精确解剖结构方面，MRI优于骨扫描，这在脊髓骨髓炎及术前极为重要。骨扫描一次检查就能显示整个骨骼，如果没有明确的定位或怀疑有多发性骨髓炎，骨扫描更受青睐。很少需要进行标记白细胞闪烁扫描。然而，由于辐射暴露水平高，儿童不应使用67Ga扫描。详细描述了不同的成像方式，并概述了成像诊断检查流程。
