Imaging pediatric osteomyelitis: The role of 99mTc-HDP bone scintigraphy and the additional value of SPECT/CT imaging - Case Report

Sep 29, 2026

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Diagnosing pediatric osteomyelitis is difficult because symptoms can be nonspecific and inflammatory markers and early laboratory results may be normal or misleading. Timely, accurate identification is critical to avoid chronic infection and growth disturbances. Two cases are presented: an 18-month-old girl with talar osteomyelitis and a 14-month-old boy with L5 vertebral osteomyelitis, both localized using triple-phase bone scintigraphy with SPECT/CT, especially when MRI is logistically challenging.

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Abstract

Case report #1

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Discussion

Radiology Ca s e Reports 21 (2026) 1086 – 1091 Available online [at](at www.sciencedirect.com)[ www.sciencedirect.com](at www.sciencedirect.com) journal [homepage:](homepage: www.elsevier.com/locate/radcr)[ www.elsevier.com/locate/radcr](homepage: www.elsevier.com/locate/radcr) | Case Report
Imaging pediatric osteomyelitis: The role of 99mTc-HDP bone scintigraphy and the additional value of SPECT/CT imaging✩
Saxby Brown, MBBS, MMedPhysa,∗, Eva A. Wegner, BMed, FRACP, FAANMS, MHMa,b, Monica A. Rossleigh, MBBS, MD, FRACP, FAANMSa,b
a Department of Nuclear Medicine, Prince of Wales and Sydney Children’s Hospital, Barker Street, Randwick, NSW 2031, Australia
b The University of New South Wales, Faculty of Medicine, Cnr High Street & Botany Street, Kensington, NSW 2033, Australia | | | | --- | --- | --- | | a r t i c l e i n f o | | a b s t r a c t | | Article history:
Received 28 September 2025 Revised 19 November 2025 Accepted 20 November 2025 | | Diagnosing pediatric osteomyelitis can be challenging due to its often nonspecific symptoms and the potential for early or misleadingly normal laboratory results. Early and accurate diagnosis is essential to prevent long-term complications. This report discusses 2 cases: an 18-month-old girl with a 4-week history of a worsening right leg limp and refusal to weight-bear, presenting afebrile and with normal inflammatory markers, where triplephase bone scintigraphy with SPECT/CT was crucial in diagnosing talar osteomyelitis; anda 14-month-old boy presenting with a 5-day history of refusing to walk and mildly raised inflammatory markers, where triple-phase bone scintigraphy with SPECT/CT identified the presence of L5 vertebral osteomyelitis. These 2 cases demonstrate the utility of whole body bone scintigraphy and the additional value in SPECT/CT acquisition in accurately localizing osteomyelitis in children, particularly when other investigations are nondiagnostic or symptoms are not clearly localized, or when MRI is logistically challenging due to the requirement for general anesthesia.
© 2025 The Authors. Published by Elsevier Inc. on behalf of University of Washington.
This is an open access article under the CC BY license
([http://creativecommons.org/licenses/by/4.0/](http://creativecommons.org/licenses/by/4.0/)) | | Keywords: Osteomyelitis Bone scintigraphy SPECT/CT Pediatric
Talar bone Lumbar spine | | | for the metaphysis due to its high vascularity and susceptibility to trauma [1]. The diagnosis of acute osteomyelitis presentsa clinical challenge, as common presenting symptoms such as fever, lethargy, or irritability are nonspecific, and early investigations are often normal [2]. Notably, blood cultures identify the causative organism in only 50% of cases [3]. Early diagno- ✩ Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. ∗ Corresponding author. E-mail address: [saxby.brown@health.nsw.gov.au](saxby.brown@health.nsw.gov.au) (S. Brown). [https://doi.org/10.1016/j.radcr.2025.11.062](https://doi.org/10.1016/j.radcr.2025.11.062) 1930-0433/© 2025 The Authors. Published by Elsevier Inc. on behalf of University of Washington. This is an open access article under the CC BY license ([http://creativecommons.org/licenses/by/4.0/](http://creativecommons.org/licenses/by/4.0/)) Fig. 1 – Blood-pool imaging of the lower limbs, showing subtle asymmetrical soft tissue hyperemia at the right ankle. sis and treatment are important to prevent long-term complications, such as chronic infection or growth disturbances [4] . Plain radiography is the standard initial investigation but often fails to definitively diagnose acute osteomyelitis, as bony changes may not be apparent for approximately 14 days [5,6] . Ultrasound and diagnostic CT have specific adjunctive roles; ultrasound offers good sensitivity for su

FAQs

Why is pediatric osteomyelitis hard to diagnose early?

Symptoms are often nonspecific (e.g., fever or irritability may be absent), and inflammatory markers or early investigations can be normal or misleading.

What imaging strategy was emphasized in these cases?

Triple-phase bone scintigraphy combined with SPECT/CT was crucial for accurately localizing osteomyelitis in children.

When is SPECT/CT particularly valuable compared with MRI?

SPECT/CT provides a diagnostic alternative when MRI is difficult to perform in young children due to the need for general anesthesia or deep sedation.

Sep 29, 2026

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