Differential diagnosis between osteomyelitis and bone tumors

Abstract

The penumbra sign and a high CRP level support the diagnosis of osteomyelitis and may help to exclude the presence of a tumor.

A case of chickenpox complicated with subacute osteomyelitis

“…Penumbra sign is defined on T1-weighted images as a higher signal intensity because of the thin layer of granulation tissue that lines the lesion. The sensitivity of the penumbra sign for osteomyelitis was 77.3% and specificity was 99.1% [14]. In our case high CRP level and the presence of penumbra sign (Fig.…”

“…In the study of Shimose et al, all 244 cases that had initial diagnosis of bone tumor were histologically examined and it was seen that 15 cases had subacute/chronic osteomyelitis, 83 cases had malignant, 77 cases had benign bone tumors and 69 cases had tumor-like lesions [14]. Sensitivity and specificity of the elevated CRP for osteomyelitis was found 60% and 90.8%, respectively [14]. Penumbra sign is defined on T1-weighted images as a higher signal intensity because of the thin layer of granulation tissue that lines the lesion.…”

“…Hence it is hard to discriminate malignant bone tumors like Ewing sarcoma and osteosarcoma from subacute and chronic osteomyelitis solely by clinical and radiological findings, biopsy is recommended if appropriate response is not reached after antibiotic treatment [13,14]. In the study of Shimose et al, all 244 cases that had initial diagnosis of bone tumor were histologically examined and it was seen that 15 cases had subacute/chronic osteomyelitis, 83 cases had malignant, 77 cases had benign bone tumors and 69 cases had tumor-like lesions [14]. Sensitivity and specificity of the elevated CRP for osteomyelitis was found 60% and 90.8%, respectively [14].…”

Successful Management of Infected Intramedullary Nailing With Reaming, Lavage, and Insertion of Antibiotic-Impregnated Cement Rods

“…For the other six patients having normality in CRP levels, the success of their treatment was monitored with clinical and radiographic evaluations. An normal CRP level is not conflict with the diagnosis of osteomyelitis as reported by many authors, 28,29 maybe because of long-term antibiotic therapy or multiple surgeries. To some degree, the routine use of vancomycin in treating osteomyelitis may increase the bacterial resistance to antibiotics.…”

The “Penumbra Sign” on Magnetic Resonance Images of Brodie’s Abscess: A Case Report

“…This sign on MRI has a sensitivity of 75% and specificity, positive and negative predictive values all higher than 90% in the diagnosis of subacute osteomyelitis [3][4][7]. …”