Imaging Modalities for Differentiating Bone Infarction and Osteomyelitis in Sickle Cell Disease: A Literature Review

Sickle cell disease (SCD) is a hereditary hemoglobinopathy associated with frequent acute and chronic skeletal complications. Among these, vaso-occlusive crises (VOCs)-induced bone infarctions and osteomyelitis are two critical yet clinically overlapping conditions that pose a diagnostic challenge. Accurate differentiation between the two is essential, as they require markedly different treatment strategies, conservative management for VOCs versus antibiotic therapy, and possible surgical intervention for osteomyelitis. This comparative review explores various imaging modalities' roles, advantages, and limitations, including plain radiography, ultrasonography, magnetic resonance imaging (MRI), and radionuclide scans, such as bone and labeled leukocyte imaging. While no single modality has emerged as the gold standard, MRI and combined radionuclide approaches demonstrate promising sensitivity and specificity when interpreted alongside clinical and laboratory findings. This paper also highlights the limitations of various imaging techniques, underscores the necessity of correlating imaging findings with clinical data, and addresses the risk of misdiagnosis. A comprehensive understanding of the imaging characteristics of these complications is crucial for orthopedic surgeons, hematologists, radiologists, and infectious disease specialists involved in the care of patients with SCD. This review emphasizes a multimodal diagnostic approach tailored to the clinical context, aiming to guide clinicians in optimizing patient care for individuals with SCD presenting with acute bone pain.