Results of three-phase bone scintigraphy and radiography in 20 cases of neonatal osteomyelitis

Neonatal osteomyelitis, a rare, potentially crippling disease, requires early diagnosis and effective therapy. This study of 20 neonates analysed the diagnostic value of three-phase bone scintigraphy (motivated by its controversial role), plain radiography and local clinical signs in neonatal osteomyelitis and complicating septic arthritis. The sensitivities for detecting focal skeletal involvement were as follows: bone scintigraphy 90%, radiography 65%, clinical local signs 20%. Reliable scintigraphic signs were localized hyperperfusion (phase I), vasodilation (phase II) and hot or cold lesions on 3-h images. Radionuclide angiography definitely increased the validity of bone scintigraphy. During follow-up, the reduction or normalization in focal hyperperfusion was the first and most sensitive sign of an adequate response to antibiotic treatment; persistence (or recurrence) of focal hyperperfusion, increasing relative uptake ratios and the appearance of new foci of bone involvement indicated escape from antibiotic therapy. Radiography revealed no pathological signs in 35% of cases, soft tissue changes in 20% and effusion of the hip joint in 45%. Local clinical signs were not a reliable predictor of scintigraphic or radiographic findings. We consider bone scintigraphy in neonatal osteomyelitis to be a successful, efficient and cost-effective diagnostic modality, not only for early diagnosis, but also during follow-up.