What is the role of bone scanning in the workup of fever of unknown origin (FUO)?

Updated: May 17, 2021
  • Author: Sandra G Gompf, MD, FACP, FIDSA; Chief Editor: Michael Stuart Bronze, MD  more...
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Whereas plain radiographs may not show changes for weeks after the onset of infection, technetium bone scan may be a more sensitive method for documenting skeletal involvement when osteomyelitis is suspected. Magnetic resonance imaging (MRI) is considered the criterion standard for detection of acute osteomyelitis and delineating structural abnormalities; however, it is less sensitive in the setting of chronic osteomyelitis and prosthetic joint infection. While potentially a greater cost upfront, positron emission tomography-computed tomography (PET-CT) full-body scans are increasingly recognized as useful early in efficiently localizing abnormalities and may save other healthcare costs in the FUO workup. PET-CT is especially sensitive in localizing and detecting small foci of inflammation and metabolic activity. It is particularly superior to MRI and other nuclear imaging studies in localizing foci of osteomyelitis of the hip, vertebrae, or prosthetic devices, as well as endovascular graft infection, neoplasia, and vasculitides. [22, 24]

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