ACR Appropriateness Criteria® Suspected Spine Infection

Ortiz, A. Orlando; Levitt, Alex; Shah, Lubdha M.; Parsons, Matthew S.; Agarwal, Vikas; Baldwin, Keith; Bhattacharyya, Shamik; Boulter, Daniel; Burns, Judah; Fink, Kathleen R.; Hunt, Christopher H.; Hutchins, Troy A.; Kao, Lillian S.; Khan, Majid; Lo, Bruce M.; Moritani, Toshio; Reitman, Charles A.; Repplinger, Michael D.; Shah, Vinil; Singh, Simranjit; Timpone, Vincent M.; Corey, Amanda S.

doi:10.1016/j.jacr.2021.09.001

Cited by 9 publications

(7 citation statements)

References 68 publications

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“…MRI is a powerful diagnostic tool in assessing cervical spine infections, including osteomyelitis, discitis, and epidural or paraspinal abscesses. 7 Typical MRI findings include bone and soft-tissue high signal intensity on fluid-sensitive T2-weighted images, joint effusion, fluid collections and bone and/or soft-tissue contrast enhancement. 8 MRI is more sensitive than computed tomography while avoiding radiation exposure and more specific than nuclear scintigraphy in identifying vertebral osteomyelitis.…”

Section: Discussionmentioning

confidence: 99%

Septic Arthritis of the Atlanto-Occipital Joint Caused By S. Intermedius in a 5-Year-Old Girl: A Case Report

Siena

Passone

Rodofile

et al. 2022

Pediatric Infectious Disease Journal

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Septic arthritis of the atlanto-occipital joint caused by Streptococcus intermedius is extremely rare. We present the first case report of this entity in a fully immunocompetent 5-year-old girl. The magnetic resonance imaging and blood tests were consistent with septic arthritis, so she started empirical antibiotic therapy. Septic arthritis should be excluded in children with torticollis, fever and neck pain.

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Section: Discussionmentioning

confidence: 99%

Septic Arthritis of the Atlanto-Occipital Joint Caused By S. Intermedius in a 5-Year-Old Girl: A Case Report

Siena

Passone

Rodofile

et al. 2022

Pediatric Infectious Disease Journal

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“…These examinations are typically used in certain situations, such as in patients in whom MRI is contraindicated or if MRI and CT are equivocal. The most important studies in this setting are gallium scan, indium 111-tagged white blood cell (WBC) scan, single-photon emission computerized tomography/computed tomography (SPECT/CT), and positron emission tomography (PET) scan [ 14 – 16 ].…”

Section: Imaging Modalitiesmentioning

confidence: 99%

“…Although Ga-67 is less sensitive (73%), it is more specific (61%) than skeletal scintigraphy. Moreover, a dual Ga-67 and Tc-99m-MDP study can increase the overall specificity of the examination to 81% with a sensitivity of 73% [ 14 ].…”

Section: Imaging Modalitiesmentioning

confidence: 99%

Imaging features of the postoperative spine: a guide to basic understanding of spine surgical procedures

Girão,

Miyahara,

Dwan

et al. 2023

Insights Imaging

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Spinal surgical procedures are becoming more common over the years, and imaging studies can be requested in the postoperative setting, such as a baseline study when implants are used, or when there is a new postoperative issue reported by the patient or even as routine surveillance. Therefore, it helps the surgeon in the appropriate management of cases. In this context, there is increasing importance of the radiologist in the adequate interpretation of postoperative images, as well as in the choice of the most appropriate modality for each case, especially among radiographs, computed tomography, magnetic resonance imaging and nuclear medicine. It is essential to be familiar with the main types of surgical techniques and imaging characteristics of each one, including the type and correct positioning of hardware involved, to differentiate normal and abnormal postoperative appearances. The purpose of this pictorial essay is to illustrate and discuss the more frequently used spine surgical interventions and their imaging characteristics, with an emphasis on classical decompression and fusion/stabilization procedures. Graphical Abstract Key points Plain radiographs remain the main modality for baseline, dynamic evaluation, and follow-ups. CT is the method of choice for assessing bone fusion, hardware integrity and loosening. MRI should be used to evaluate bone marrow and soft tissue complications. Radiologists should be familiar with most performed spinal procedures in order to differentiate normal and abnormal. Critical relevance statement This article discusses the main surgical procedures involved in the spine, which can be didactically divided into decompression, stabilization-fusion, and miscellaneous, as well as the role of diagnostic imaging methods and their main findings in this context.

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“…Critical spinal epidural pathologies such as epidural hematomas, abscesses, and phlegmon can cause paralysis or death if left untreated 1,2. Magnetic resonance imaging (MRI) is largely favored over computed tomography (CT) for spinal imaging when these pathologies are suspected 3,4. However, patients acutely presenting with emergent symptoms of spinal pathologies are more commonly initially imaged with CT. Epidural lesions on CT are sometimes missed by radiologists in practice, and postsurgical CT exams with metallic implants are particularly limited due to artifacts.…”

mentioning

confidence: 99%

“…1,2 Magnetic resonance imaging (MRI) is largely favored over computed tomography (CT) for spinal imaging when these pathologies are suspected. 3,4 However, patients acutely presenting with emergent symptoms of spinal pathologies are more commonly initially imaged with CT. Epidural lesions on CT are sometimes missed by radiologists in practice, and postsurgical CT exams with metallic implants are particularly limited due to artifacts. Therefore, methods to aid radiologist identification of epidural lesions on CT are warranted.…”

mentioning

confidence: 99%

Detection of Critical Spinal Epidural Lesions on CT Using Machine Learning

Harris

Baginski

Bronstein

et al. 2022

Spine

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Background. Critical spinal epidural pathologies can cause paralysis or death if untreated. Although magnetic resonance imaging is the preferred modality for visualizing these pathologies, computed tomography (CT) occurs far more commonly than magnetic resonance imaging in the clinical setting. Objective. A machine learning model was developed to screen for critical epidural lesions on CT images at a large-scale teleradiology practice. This model has utility for both worklist prioritization of emergent studies and identifying missed findings. Materials and Methods. There were 153 studies with epidural lesions available for training. These lesions were segmented and used to train a machine learning model. A test data set was also created using previously missed epidural lesions. The trained model was then integrated into a teleradiology workflow for 90 days. Studies were sent to secondary manual review if the model detected an epidural lesion but none was mentioned in the clinical report. Results. The model correctly identified 50.0% of epidural lesions in the test data set with 99.0% specificity. For prospective data, the model correctly prioritized 66.7% of the 18 epidural lesions diagnosed on the initial read with 98.9% specificity. There were 2.0 studies flagged for potential missed findings per day, and 17 missed epidural lesions were found during a 90-day time period. These results suggest almost half of critical spinal epidural lesions visible on CT imaging are being missed on initial diagnosis. Conclusion. A machine learning model for identifying spinal epidural hematomas and abscesses on CT can be implemented in a clinical workflow.

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ACR Appropriateness Criteria® Suspected Spine Infection

Cited by 9 publications

References 68 publications

Septic Arthritis of the Atlanto-Occipital Joint Caused By S. Intermedius in a 5-Year-Old Girl: A Case Report

Septic Arthritis of the Atlanto-Occipital Joint Caused By S. Intermedius in a 5-Year-Old Girl: A Case Report

Imaging features of the postoperative spine: a guide to basic understanding of spine surgical procedures

Detection of Critical Spinal Epidural Lesions on CT Using Machine Learning

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