Infection of the Skeletal System

In our daily routine, we are often confronted with infection of bones in various forms. Several questions may arise: Is imaging able to confirm the clinical suspicion, as in cases of posttraumatic osteomyelitis? Has the soft tissue infection spread to the bones, as in the diabetic foot? Does imaging support the straightforward diagnosis of osteomyelitis without the need for biopsy, as in chronic recurrent multifocal osteomyelitis (CRMO)? Is osteomyelitis a likely diagnosis in the work-up of an osteolytic lesion? These are all difficult questions covering an array of concerns.

The prospects are good for answering these questions correctly in the case of skeletal infection. This issue of Seminars in Musculoskeletal Radiology includes seven review articles devoted to a multimodality approach to diagnose the various forms of infection and inflammation of the bones. The importance of plain radiographs is stressed. Magnetic resonance imaging (MRI), which has dramatically improved the imaging of osseous and soft tissue infections, is well covered. The role of scintigraphic methods for a prompt and specific diagnosis of osteomyelitis is discussed in detail. Moreover, infection of the bones serves as an example of the paramount importance of physical examination and laboratory findings, which must be taken into account for a final diagnosis and which sum up all imaging findings.

Drs. Gil and Morrison from Philadelphia start our survey with an overview of MR imaging of the diabetic foot. They address the different aspects of this disease and its differential diagnosis. Drs. Bühne and Bohndorf from Germany follow, discussing abnormalities seen in cases of chronic posttraumatic osteomyelitis. Scintigraphic techniques are a foundation in the diagnosis of musculoskeletal infection. This aspect is covered thoroughly by Dr. Sciuk from Germany. Our colleagues from England, Drs. Tins and Cassar-Pullicino, contribute to the issue their extensive knowledge about MRI of spinal infection. The article by Dr. Arkum from Turkey deals exclusively with the difficult subject of unusual infections of fungal, viral, and parasitic origins. Dr. Jurik from Denmark has worked extensively on the subject of CRMO, which principally affects children, and provides detailed information about this disease.

Drs. Saigal, Azouz, and Abdenour from Miami conclude this issue, reviewing the different forms of osteomyelitis with special reference to children.

I thank the editors, David Karasick, M.D. and Mark E. Schweitzer, M.D., for the honor of inviting me to be guest editor of this issue. I can count myself lucky to have been able to recruit an excellent cast of experienced authors for completion of this text; I am grateful to them. The work of Erik Wenskus and his colleagues from Thieme Medical Publishers is also highly acknowledged.