The intensity of the gallium uptake on the bottom two images is greater than that of the delayed bone scan on the top two images. One third of patients have evidence of osteomyelitis. Contributing factors include angiopathy and peripheral neuropathy. Radiography Radiographs can vary in appearance. They can be normal or demonstrate soft tissue swelling, periosteal reaction, subperiosteal bone resorption, and erosions and sequestra.
Radiographs are the least sensitive method of diagnosis.
The uptake in three phase bone scans is related to blood flow and osteoblastic activity. Gallium has a proven role in the monitoring of treatment. Images are obtained at 2 to 4 hours as well as 24 hours. Drawbacks include the low count rate, cost of the radiopharmaceutical preparation, complexity of the labeling and lack of bony landmarks. It is considered to be the most sensitive modality.