Bone scan patterns in acute osteomyelitis

Sixteen patients with acute hematogenous osteomyelitis underwent serial Tc-99m-diphosphonate bone scanning on admission and at intervals of four to seven days thereafter. Scans were analyzed by computer-assisted determination of the ratio of activity in the lesion to that in a corresponding area of normal bone. Two patterns were observed. In seven children this ratio was low initially and increased during hospitalization despite clinically adequate therapy. In nine children the ratio was high initially and decreased during therapy. Lack of focal uptake within bone on the initial scan performed within the first three days of the onset did not exclude the diagnosis of osteomyelitis.