Which imaging modalities are most effective for diagnosing osteomyelitis in primary care settings?

In primary care settings, the most effective initial imaging modality for diagnosing osteomyelitis is plain X-ray, as it is widely available and can identify bone abnormalities suggestive of infection. However, early changes of osteomyelitis may not be visible on X-rays, especially within the first 10-14 days of infection onset. Therefore, if clinical suspicion remains high despite a normal X-ray, referral for magnetic resonance imaging (MRI) is recommended because MRI is more sensitive and can detect early bone marrow oedema and inflammation before structural changes appear on X-ray. MRI also provides detailed information about the extent of infection and involvement of adjacent soft tissues, which is crucial for management decisions. Computed tomography (CT) may be used if MRI is contraindicated or unavailable, but it is less sensitive than MRI for early osteomyelitis. Ultrasound has limited utility in diagnosing osteomyelitis but may help identify associated soft tissue abscesses. In summary, plain X-ray is the first-line imaging in primary care, with MRI as the preferred advanced imaging modality for confirmation and detailed assessment when osteomyelitis is suspected but not confirmed by X-ray NICE NG33; Harmer et al. 2011.