In pediatric patients, the metaphyses of long bones are a common site for osteomyelitis secondary to the increased vascularity to this region in developing bone. On bone scan, osteomyelitis is typically 'three phase positive' with increased blood flow and hyperemia on early phase imaging, and intense increased tracer accumulation (osteoblastic activity) on delayed phase imaging. SPECT/CT is useful for anatomical localization, improving the specificity of nuclear medicine bone scan. 

Physes will demonstrate linear increased tracer accumulation, which is physiological. Assessing for assymetry between sides is useful when localizing pathology. A traumatised or infected growth plate will usually demonstrate increased osteoblastic activity compared to the normal contralateral side.