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

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 triple-phase bone scintigraphy with SPECT/CT was crucial in diagnosing talar osteomyelitis; and a 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.