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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Is A Bone Scan Needed While Having No Evidence Of Osteomyelitis?

SUBJECT: MRI & BONE SCAN. Hello Dr Bhargava, hope you re doing well. I underwent an MRI recently. Have pain & swelling following injury to my left foot. It s been a few months now since the pain & swelling started. The swelling is in the great tow & the two toes adjacent to it, & all over the forefoot. Due to the swelling, there s ulcer on the great toe & the one adjacent to it since beginning of Oct. My doctor put me on Antibiotics since Mid Oct. As per him, it s Erysipelas/Cellulitis. My foot is slightly better now in terms of pain. Swelling still persists. MRI findings: A tiny cyst with adjacent edema is seen distally within the distal phalanx of the great toe. May represent a low grade contusion & a tiny post-traumatic cyst. Osseous structures are unremarkable with no evidence of osteomyelitis. Visualized flexor & extensor tendons are unremarkable. Lisfranc ligament is intact. Mild subcutaneous edema of the left forefoot which is nonspecific. Impression: Possible low grade contusion & tiny post-traumatic cyst within the distal phalanx of the great toe. Mild subcutaneous edema of the left forefoot which is nonspecific. Now, my Doctor has ordered a Bone Scan. My question: Is a Bone Scan really necessary even though the Osseous structures are unremarkable with no evidence of osteomyelitis? Please reply ASAP Thanks very much in advance. Anita
Tue, 29 Dec 2015
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Radiologist,  's  Response
Hi,
Thanks for writing in.

Some times a MRI scan is not sufficient to make a confirmed diagnosis because of findings which are non specific and which are found in many conditions. Bone scan tell us about any problems in mineralisation of the bone in early stage. MRI picks up bone problems but bones scan does it earlier.

In your MRI foot it is seen that there is a small cyst in the distal phalynx of the great toe. This is raising suspicion if it is following trauma or some process in going on in the bone. There is swelling in the soft tissues of the front of foot and this is mild in nature. The bone scan will tell if there is any increased activity and this can help know the problem. There can be inflammatory changes in the bone which are not noticed in the MRI scan of the foot. Please do not worry.
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Is A Bone Scan Needed While Having No Evidence Of Osteomyelitis?

Hi, Thanks for writing in. Some times a MRI scan is not sufficient to make a confirmed diagnosis because of findings which are non specific and which are found in many conditions. Bone scan tell us about any problems in mineralisation of the bone in early stage. MRI picks up bone problems but bones scan does it earlier. In your MRI foot it is seen that there is a small cyst in the distal phalynx of the great toe. This is raising suspicion if it is following trauma or some process in going on in the bone. There is swelling in the soft tissues of the front of foot and this is mild in nature. The bone scan will tell if there is any increased activity and this can help know the problem. There can be inflammatory changes in the bone which are not noticed in the MRI scan of the foot. Please do not worry.