E4626. Nomenclature and Key Imaging Findings for Bone Infections
  1. Steven Chen; Stony Brook University Hospital
  2. Max Hao; Stony Brook University Hospital
  3. Musa Mufti; Stony Brook University Hospital
Osteomyelitis is an infection of bone that can cause extensive bone destruction or necrosis if not treated in a timely manner. Acute osteomyelitis occurs over days to weeks, whereas chronic osteomyelitis is present for at least 1 month. Acute osteomyelitis can lead to subperiosteal or intraosseous abscesses, and chronic osteomyelitis can lead to cloaca, involucrum, or sequestrum. An array of imaging techniques is often used in the work up; radiography is first-line screening when there is clinical suspicion, and CT or MRI are used for further characterization. Although MRI has the highest sensitivity and specificity for detecting acute osteomyelitis, sequestrum or cloaca from chronic osteomyelitis are sometimes better visualized on CT scans. Describing these imaging findings can often be confusing to radiology trainees due to poorly defined terms with variable meaning. It is important for radiologists to recognize the diverse imaging findings for osteomyelitis and use clear, proper terminology when describing these images, thus providing recommendations in a manner most beneficial for referring physicians.

Educational Goals / Teaching Points
The goal of this educational exhibit is to provide a case-based review of acute and chronic osteomyelitis, examine the associated complications of each, and discuss noteworthy features on radiographic, CT, and MRI. Define the nomenclature of various bone infections based on the Society of Skeletal Radiology 2021 guidelines. Review the radiographic, CT, and MRI findings of bone infections. Discuss management of various bone infections, thus aiding us in tailoring our reports to be more clinically relevant.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Radiographic, CT, and MRI findings for osteomyelitis. Complications of acute osteomyelitis: subperiosteal abscess, and intraosseous abscess. Complications of chronic osteomyelitis: cloaca, involucrum, and sequestrum.

Osteomyelitis is a potential life-threatening, highly destructive bone infection that can require multiple different imaging modalities for diagnosis and management. Consistent, clear terminology when describing these findings is essential for a meaningful clinical impact. Thus, an ability to recognize the key features of osteomyelitis in a variety of imaging techniques is tantamount, enabling radiologists to make precise diagnoses and offer impactful clinical recommendations to referring physicians.