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. 2019 Dec 21;9(1):32.
doi: 10.3390/jcm9010032.

Impact of MRI, CT, and Clinical Characteristics on Microbial Pathogen Detection Using CT-Guided Biopsy for Suspected Spondylodiscitis

Alexander Braun  1 , Thomas Germann  1 , Felix Wünnemann  1 , Marc-André Weber  2 , Marcus Schiltenwolf  3 , Michael Akbar  3 , Iris Burkholder  4 , Hans-Ulrich Kauczor  1 , Christoph Rehnitz  1
Affiliations

Impact of MRI, CT, and Clinical Characteristics on Microbial Pathogen Detection Using CT-Guided Biopsy for Suspected Spondylodiscitis

Alexander Braun et al. J Clin Med. .

Abstract

Spondylodiscitis accounts for 2-7% of osteomyelitis cases and is characterized by pain, systemic inflammation, and permanent neurological deficits. We aimed to identify imaging characteristics and clinical parameters to successfully predict microbiological pathogens by computed tomography (CT)-guided biopsy in suspected spondylodiscitis cases. Forty consecutive patients (mean age 65.1 years) with suspected spondylodiscitis underwent CT-guided biopsy. CT features (non-sclerotic endplate erosions (NSEs)), magnetic resonance criteria (paravertebral/epidural abscess (PA/EA) formation), and clinical data (C-reactive protein (CRP) > 50 mg/L) were assessed for their predictive potential. NSEs were detected in 6/11 (54.5%) and 1/29(3.4%) patients with positive and negative microbiology, respectively. PA and EA, respectively, were present in 7/11(63.6%) and 3/11 patients with positive microbiology and 7/29 (24.1%) and 2/29 patients with negative microbiology. CRP > 50 was observed in 7/11 (63.6%) and in 7/29 (24.1%) patients with positive and negative microbiology, respectively. Three double combinations possessed near-perfect specificity (PA + NSE, 100%; PA + CRP > 50, 96.6%; NSE + CRP > 50, 96.6%). The top three Youden indices included combinations with NSE. Since CT/magnetic resonance (MR) imaging and CRP are routinely used to evaluate spondylodiscitis, the presented diagnostic criteria and combinations can aid decision-making for biopsy.

Keywords: CRP; CT; MRI; biopsy; microbiology; spondylodiscitis.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Coronal T1 weighted, fat-saturated, contrast-enhanced magnetic resonance (MR) image of the lumbar spine at the level L1-L3. A paravertebral abscess in the left psoas muscle of a 53-year old patient is present (arrow). The detected pathogen after computed CT-guided biopsy was Staphylococcus aureus.
Figure 2
Figure 2
Transversal T1 weighted, fat-saturated, contrast-enhanced image of the lumbar spine level L5/L6 in a 52-year old patient. An epidural abscess is present (arrow). The detected pathogen after CT-guided biopsy was E. coli.
Figure 3
Figure 3
Sagittal T1 weighted, fat-saturated, contrast-enhanced image of the lumbar spine level L5-S1 in the same patient as shown in Figure 2. The epidural abscess in the spinal canal is marked with an arrow.
Figure 4
Figure 4
CT scan (sagittal reconstruction) of thoracic spine level Th6-Th7 showing non-sclerotic erosions of adjacent endplates of the thoracic spine in 55-year old patient. The detected pathogen after CT-guided biopsy was E. coli.
Figure 5
Figure 5
CT scan (sagittal reconstruction) of lumbar spine level L2-L3. As opposed to Figure 4 showing marginally sclerotic erosions of adjacent endplates of the lumbar spine in 77-year old patient. No detected pathogen after CT-guided biopsy.
Figure 6
Figure 6
Simplified decision-support pathway regarding probability of pathogen detection following CT-guided biopsy based on imaging and laboratory findings in suspected spondylodiscitis.
See this image and copyright information in PMC

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