Is Biopsying the Paravertebral Soft Tissue as Effective as Biopsying the Disk or Vertebral Endplate? 10-Year Retrospective Review of CT-Guided Biopsy of Diskitis-Osteomyelitis

Abstract

Paravertebral soft-tissue changes, when present, may be considered a viable target for biopsy in cases of diskitis-osteomyelitis, even in the absence of a paravertebral abscess.

Spondylodiscitis following endovascular abdominal aortic aneurysm repair: imaging perspectives from a single centre’s experience

“…The 3 patients with no causative organism identified comprised 2 patients with culture-negative spinal biopsies and 1 patient with a culture-negative biopsy of the paravertebral collection. This is in line with previous studies that have highlighted the limited positive yield of CT-guided spinal biopsies (42–57%), and a moderately higher yield obtained from the biopsy of a paravertebral phlegmon/abscess (68%) [ 21 – 23 ].…”

Culture yield of repeat percutaneous image-guided biopsy after a negative initial biopsy in suspected spondylodiscitis: a systematic review

“…Variation in anatomical targets may also have affected culture yields. On the other hand, a previous study has shown that there were no statistically significant differences between the yields of endplate-disc, disc-only, and paravertebral soft-tissue biopsies [ 20 ]. Despite the variations in patient populations and methodology among the studies included, proportions of positive culture yields among second biopsies were statistically homogeneous, but this may be due to the relatively small sample sizes of the studies included.…”

Spondylodiscitis: Diagnosis and Treatment Options

“…More recent literature shows that pathogen detection can be improved using a combined magnetic resonance imaging (MRI)/CT investigation involving superimposition of the respective image data prior to fine-needle biopsy (14,15). According to Kim et al, the pathogen detection rate is 2.28 times higher following soft tissue investigation compared with bone tissue (16), whereas in their retrospective analysis (126 tissue biopsies), Chang et al demonstrated that there is an approximately significant difference in specificity/sensitivity in relation to the type of biopsy tissue (sensitivity/ specificity end plate vs. paravertebral soft tissue: 38%/86% vs. 68%/92%, p = 0.09; disc vs. endplate: 57%/89% vs. 38%/86%; p = 0.05) (16,17).…”

“…Low pathogen detection rate using CT-guided fine needle aspiration in patients with high radiological and clinical likelihood of infection (30.4%) (2012) (13) Fine needle aspiration using combined MRI/CT data increases the pathogen detection rate (36%) (2016) (14) Combined MRI/CT data increases the detection rate (100% sensitivity, 50% specifcity) (2016) (15) In the case of suspected adjacent soft tissue abscess formation, soft tissue is superior to bone tissue for pathogen detection (odds ratio: 2.28; 95% CI: [1.08; 4.78]) (2015) (16) There is no statistically significant difference (p<0.05) in specificity and sensitivity according to biopsy tissue (sensitivity/specificity end plate vs. paravertebral soft tissue 38%/86% vs. 68%/92%, p = 0.09; disc vs. end plate: 57%/89% vs. 38%/86%; p = 0.05) (2015) (17) MRI remains the gold standard (2012) (e8) High specificity (88%; 95% CI: [0.74; 0.95]) and sensitivity (97%; 95% CI: [0.83; 1.00]) to detect spondylodiszitis (2014) (18) MRI (98%) with better sensitivity than PET-CT (95%); but PET-CT has better specificity (86% vs. 67%), particularly in the differentiation between postoperative/severe degenerative changes and spondylodiscitis (2014) (19) PET-CT as a helpful diagnostic tool if concomitant degenerative changes are present (Modic I); differentiation between Modic I changes and spondylodiscitis simplified by PET-CT (2010) (20) IV IV III III III II V III III III III IV V I III II…”