Imaging study	Sensitivity (%)	Specificity (%)	Comments
Plain radiography	43 to 75	65 to 83	Lateral, anteroposterior, and oblique views should be done initially in all patients with diabetes who are suspected to have a deep infection
			Because 30 to 50 percent of the bone must be destroyed before lytic lesions appear, plain radiography should be repeated at two-week intervals if initial findings are not normal, but the infection fails to resolve
			Soft tissue swelling and subperiosteal elevation are the earliest findings of osteomyelitis on plain radiography
Magnetic resonance imaging	82 to 100	75 to 96	Useful in between soft tissue and bone infection and for determining the extent of infection
			Should be considered for patients with diabetes who have an infection with no bone exposed, who have been treated for two to three weeks with modest clinical improvement, and who have negative or inconclusive results on plain radiography
Technetium-99m methylene diphosphonate bone scan	69 to 100	38 to 82	High sensitivity for osteomyelitis and can differentiate it from cellulitis
			Abnormal findings for osteomyelitis (which typically become evident within 24 to 48 hours after onset of symptoms) include increased flow activity, blood pool activity, and positive uptake on three-hour images
			Specificity for osteomyelitis is decreased in patients with diabetes who have Charcot's foot or recent trauma or surgery; further imaging is usually required
Gallium-67 citrate scan	25 to 80	67 to 85	Sensitivity and specificity are increased when combined with technetium bone scan
Technetium-99m hexamethyl-propyleneamine oxime-labeled white blood cell scan	90	80 to 90	The main advantage is the marked improvement in specificity when combined with technetium bone scan
Computed tomography	24 to 67	50	Should not be used as part of regular osteomyelitis imaging
			Superior to magnetic resonance imaging for detecting sequestra