Introduction: A variety of diagnostic imaging techniques is available for excluding or confirming chronic osteomyelitis(COM).

Aim of the study was to determine the accuracy of current imaging modalities, radiography, MRT, CT, leukocyte (LS), bone (BS), and Galium (Ga) scintigraphy, and FDG-PET, for diagnosing COM.

Materials and methods: Systematic review and meta-analysis of the literature for clinical studies on COM evaluating diagnostic imaging modalities by a comprehensive search of the Mediine, Embase, and Current Contents databases. The value of each imaging technique was studied through its sensitivity and specificity compared to histology / culture / clinical follow-up.

Results: In total 23 clinical studies were included, describing the diagnostic accuracy of 39 imaging modalities: Radiography (2), MRI (4), CT (1), BS (5), LS (13), Ga (1), combined BS-LS (5), combined BS-Ga (3), combined LS-Ga (1), and FDG-PET (4). A high diagnostic accuracy of FDG-PET was found for detecting COM in the central and peripheral skeleton. Subgroup analyses revealed that LS is more accurate for detecting peripheral localizations of COM than for central localizations of COM.

Conclusions: The available diagnostic studies for COM are characterized by a low methodological quality. Despite, FDG-PET demonstrated to be an important new imaging technique with a high diagnostic accuracy and has the potential advantage for quantitative assessment on surgical treatment of COM.