The diagnosis and management of chronic nonspinal osteomyelitis can be challenging, and guidelines regarding the appropriateness of performing percutaneous image-guided biopsies to acquire bone samples for microbiological analysis remain limited. An expert panel convened by the Society of Academic Bone Radiologists developed and endorsed consensus statements on the various indications for percutaneous image-guided biopsies to standardize care and eliminate inconsistencies across institutions. The issued statements pertain to several commonly encountered clinical presentations of chronic osteomyelitis and were supported by a literature review. For most patients, MRI can help guide management and effectively rule out osteomyelitis when performed soon after presentation. Additionally, in the appropriate clinical setting, open wounds such as sinus tracts and ulcers, as well as joint fluid aspirates, can be used for microbiological culture to determine the causative microorganism. If MRI findings are positive, surgery is not needed, and alternative sites for microbiological culture are not available, then percutaneous image-guided biopsies can be performed. The expert panel recommends that antibiotics be avoided or discontinued for an optimal period of 2 weeks prior to a biopsy whenever possible. Patients with extensive necrotic decubitus ulcers or other surgical emergencies should not undergo percutaneous image-guided biopsies but rather should be admitted for surgical debridement and intraoperative cultures. Multidisciplinary discussion and approach are crucial to ensure optimal diagnosis and care of patients diagnosed with chronic osteomyelitis.

© RSNA, 2024

慢性非脊髓骨髓炎的诊断和治疗可能具有挑战性，并且有关进行经皮图像引导活检以获取骨样本进行微生物分析的适当性的指南仍然有限。由学术骨放射学家协会召集的专家小组就经皮图像引导活检的各种适应症制定并认可了共识声明，以标准化护理并消除机构之间的不一致。所发表的声明涉及慢性骨髓炎的几种常见临床表现，并得到文献综述的支持。对于大多数患者来说，在就诊后不久进行 MRI 可以帮助指导治疗并有效排除骨髓炎。此外，在适当的临床环境中，开放性伤口（例如窦道和溃疡）以及关节液抽吸物可用于微生物培养以确定致病微生物。如果 MRI 结果呈阳性，则不需要进行手术，并且没有替代的微生物培养部位，则可以进行经皮图像引导活检。专家小组建议尽可能在活检前 2 周内避免或停用抗生素。患有广泛坏死性褥疮溃疡或其他外科急症的患者不应接受经皮图像引导活检，而应入院进行手术清创和术中培养。多学科讨论和方法对于确保慢性骨髓炎患者的最佳诊断和护理至关重要。

© 北美放射学会，2024