MR and CT Imaging to Optimize CT-Guided Biopsies in Suspected Spondylodiscitis

Spinal Infections: An Update

“…However, the sensitivity and specificity of CT-guided needle biopsy is lower than believed; in a recent metanalysis, a sensitivity of 52.2% (95% CI, 45.8-58.5) for CT-guided percutaneous needle aspiration biopsy for the diagnosis of spinal infections was reported [48]. Recent studies reported a higher pathogen detection rate of fine-needle aspiration with combined superimposed MR and CT imaging [49,50]. Imaging evaluation of the patients with spinal infections should include radiographs of the spine and magnetic resonance (MR) imaging with contrast medium administration [44].…”

Spondylodiscitis: Diagnosis and Treatment Options

“…Pathogen detection is 19%-30% when using CT-guided fine-needle biopsy due to the small amount of tissue available, whereas detection can be achieved in 41% using histopathological methods (13, e16). 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).…”

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

“…This is in line with the pathophysiologic consideration of NSE representing a more acute, active stage of osteitis while surrounding sclerosis is associated with more chronic and less active stages [18]. Foreman et al investigated multiple MR/CT variables with regard to pathogen detection, including lytic and mixed density endplate changes [16]. Although these patterns were more frequent in the group with positive microbiology, no CT imaging parameter was identified in order to improve the prediction of microbiologic or histologic outcomes using a multivariable regression model.…”

“…Endeavors to identify both clinical variables and imaging features predictive of microbiological pathogen detection in spondylodiscitis patients have been undertaken by several studies [6,8,15,16,21]. However, results were, in part conflicting and there still exists no consensus in the issue.…”

“…CT imaging: We investigated lesions of the adjacent endplates to evaluate the stage of osteitis evaluating whether non-sclerotic endplate lesions are present, as opposed to sclerotic endplate lesions or absence of any erosions. Non-sclerotic lesions may indicate an earlier stage of osteitis while sclerotic margins indicate the presence of longer-term inflammation [16,18,19]. Non-sclerotic endplate lesions were defined as lytic defects of the endplate without sclerosis of the surrounding bone.…”