The diagnosis of osteomyelitis is often based on radiologic results which demonstrate a lytic center with a ring of sclerosis, though bone cultures are normally required to identify the specific pathogen. Conventional radiographic evaluation of acute osteomyelitis is insufficient because bone changes are not evident for 14–21 days after the onset of infection.

• Conventional radiography is readily available, relatively inexpensive, and useful in the differentiation of infection from trauma and tumors, and it is the initial imaging test of choice for suspected osteomyelitis.
• In addition, plain radiography is often a helpful adjunct to secondary imaging studies. Unfortunately, radiographic evidence of osteomyelitis lags behind the clinical picture, and less than one third of patients have abnormalities on plain radiographs in the first 7 to 10 days after the onset of symptoms.
• Radiologic bone findings suggestive of osteomyelitis is a lytic center with a ring of sclerosis.^[1]
• Other findings include soft tissue edema and deep muscle displacement.

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  Lucent lesion in the lateral aspect of the left distal femoral epiphysis and joint effusion.
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  Air filled sinus tract which leads to to sclerosed, deformed calcaneum.
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  Lucency on the lateral margin of the metaphysis adjacent to the physis of head of left femor.
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  Proximal humeral metaphyseal lytic focus in a 25 days neonate.
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  Sclerosis of the distal tibial diaphysis associated with bone expansion and soft tissue thickening.
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  Loss of soft tissue over the great toe with lucency in the surrounding soft tissue, associated patchy osteoporosis in the underlying phalanx in a patient with diabetic foot.