Sesamoiditis and left 1st metatarsophalangeal joint septic arthritis

Discussion:

A triphasic bone scan is an extremely sensitive test for the diagnosis of osteomyelitis. The coexistent of underlying bony pathologies hinder this test's specificity and may necessitate the use of alternative test such as nuclear WBC labeled scan or MRI, however in a non-violated bone a triphasic bone scan can give the diagnosis of osteomyelitis with a high confidence.  

 The initial angiographic phase reflects the relative amount of blood flow to the area of interest, whereas the blood pool phase indicates the amount of activity that has extravasated into the tissues around the area of interest. The delayed bone phase reflects the rate of bone turnover. The classic appearance of osteomyelitis on three-phase bone scan consists of focal hyperperfusion, focal hyperemia, and focally increased bone uptake

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