CRANIAL OSTEOMYELITIS - DIAGNOSIS AND FOLLOW-UP WITH IN-111 WHITE BLOOD-CELL AND TC-99M METHYLENE DIPHOSPHONATE BONE SPECT, CT, AND MR-IMAGING

PURPOSE: To assess the usefulness of indium-lll white blood cell and t echnetium-99m methylene diphosphonate bone single photon emission comp uted tomography (SPECT), computed tomography (CT), and magnetic resona nce (MR) imaging in cranial osteomyelitis. MATERIALS AND METHODS: Twen ty-six cases (25 patients: 13 male, 12 female; mean age, 55 years) of suspected osteomyelitis were evaluated. Sixteen were postoperative. Fi nal diagnosis was established by means of bone culture in 18 eases and clinical follow-up in eight. RESULTS: Of 35 CT scans, 10 were true-po sitive (TP); three, false-negative (FN); 13, true-negative (TN); one, false-positive (FP); and eight, equivocal. Of 36 SPECT scans, 19 were TP; 13, TN; one, FP; one, FN; and two, equivocal. Of 11 MR images, fou r were TP; five, TN; and two, FN. CONCLUSION: CT is best for different iation between soft-tissue and bone infection. MR imaging is best for assessment of the calvaria and skull base. SPECT is best for assessmen t of altered bone and may be the best technique for follow-up.