Which imaging modality is most helpful for evaluating suspected chronic osteomyelitis?

• A. Ultrasound
• B. MRI
• C. X-ray
• D. CT scan

Answer: (B)

Evaluating suspected chronic osteomyelitis hinges on visualizing both bone marrow and surrounding soft tissues, and MRI provides the most complete view. It detects bone marrow edema and inflammatory changes early, before X-rays become abnormal, and offers detailed contrast-enhanced imaging that highlights infected tissue, abscesses, and sinus tracts. MRI also shows the full extent of involvement inside the marrow, across the cortex, and into adjacent soft tissues, which is crucial for planning surgical debridement or reconstruction. While CT is superb for detailing cortical destruction and sequestra and X-rays reveal chronic changes later on, MRI delivers the most sensitive and specific assessment for chronic osteomyelitis.