Optimal imaging strategy for community-acquired Staphylococcus aureus musculoskeletal infections in children

Pediatr Radiol. 2008 Aug;38(8):841-7. doi: 10.1007/s00247-008-0888-8. Epub 2008 Jun 17.


Background: Invasive musculoskeletal infections from community-acquired methicillin-resistant and methicillin-susceptible Staphylococcus aureus (CA-SA) are increasingly encountered in children. Imaging is frequently requested in these children for diagnosis and planning of therapeutic interventions.

Objective: To appraise the diagnostic efficacy of imaging practices performed for CA-SA osteomyelitis and its complications.

Materials and methods: A retrospective review was conducted of the clinical charts and imaging studies of CA-SA osteomyelitis cases since 2001 at a large children's hospital.

Results: Of 199 children diagnosed with CA-SA osteomyelitis, 160 underwent MRI examination and 35 underwent bone scintigraphy. The sensitivity of MRI and bone scintigraphy for CA-SA osteomyelitis was 98% and 53%, respectively. In all discordant cases, MRI was correct compared to bone scintigraphy. Extraosseous complications of CA-SA osteomyelitis detected only by MRI included subperiosteal abscesses (n = 77), pyomyositis (n = 43), septic arthritis (n = 31), and deep venous thrombosis (n = 12).

Conclusion: MRI is the preferred imaging modality for the investigation of pediatric CA-SA musculoskeletal infection because it offers superior sensitivity for osteomyelitis compared to bone scintigraphy and detects extraosseous complications that occur in a substantial proportion of patients.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Community-Acquired Infections / diagnosis
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Magnetic Resonance Imaging / methods*
  • Male
  • Methicillin-Resistant Staphylococcus aureus*
  • Osteomyelitis / diagnosis*
  • Radiopharmaceuticals
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Staphylococcal Infections / diagnosis*
  • Technetium Tc 99m Medronate*
  • Tomography, Emission-Computed, Single-Photon / methods*


  • Radiopharmaceuticals
  • Technetium Tc 99m Medronate