Percutaneous needle biopsy in diagnosis and identification of causative organisms in cases of suspected vertebral osteomyelitis

Sehn, Jennifer K.; Gilula, Louis A.

doi:10.1016/j.ejrad.2011.01.125

Cited by 109 publications

(78 citation statements)

References 30 publications

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“…In addition, the field strength varied from 1.5 T to 3 T. The moderate sensitivity and the specificity of pre-biopsy imaging in the case of suspected primary tumor or metastatic bone lesion in our study indicates that CT-guided biopsies are necessary for the management and prognosis of patients with bone lesions within the vertebral column. In the case of suspected infection, Sehn and Giliula reported a success rate for identifying a causative pathogen of 30.4 % whereas Garg et al observed a success rate of 19 % [19,20]. The reported data are comparable to the results of our study, as we could detect a causative pathogen in 25 % of the samples.…”

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confidence: 86%

CT-Guided Percutaneous Spine Biopsy in Suspected Infection or Malignancy: A Study of 214 Patients

Rehm

Veith

Akbar

et al. 2016

Fortschr Röntgenstr

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Zusammenfassung ▼Ziel: Retrospektive Bestimmung der Effektivität und Genauigkeit von CT-gesteuerten perkutanen Biopsien von malignen und entzündlichen Verän-derungen der Wirbelsäule und Bestimmung der Reliabilität der prä-interventionell durchgeführ-ten CT-und MRT-Bildgebung. Abstract ▼Purpose: To retrospectively determine the effectiveness and accuracy of CT-guided percutaneous biopsy of malignant and inflammatory bone lesions of the spine and to assess the reliability of pre-biopsy CT and MRI. Materials and Methods: 214 patients with lesions of the spine, which were suspicious either for being malignant or inflammatory, underwent CT-guided biopsy for pathological and/or microbiological detection. Biopsy samples were sent for histological examination in 128/214 patients, for microbiological analysis in 17/214 patients and for both analyses in 69/214 patients. Retrospectively, the diagnostic accuracy and sensitivity/specificity of the pre-interventional imaging (CT and MRI) were determined. In addition, the influence of the biopsy on subsequent patient management was assessed. Results: The accuracy was 94.4 % for histopathological analysis and 97.7 % for microbiological analysis. In 25 % of cases the microbiological analysis revealed an underlying pathogen that was not significantly affected by pre-biopsy antibiotic therapy. The sensitivity/specificity of the pre-biopsy crosssectional imaging concerning suspected malignancy was 69 %/78 %. For suspected infection, the sensitivity/specificity of pre-biopsy imaging was 81 %/ 44 %. In 52 % of all cases, the biopsy result changed subsequent patient management. Conclusion: Percutaneous CT-guided spine biopsy is a useful and reliable diagnostic procedure to establish a definitive diagnosis but with a relatively low yield of microorganisms in the case of infection.

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confidence: 86%

CT-Guided Percutaneous Spine Biopsy in Suspected Infection or Malignancy: A Study of 214 Patients

Rehm

Veith

Akbar

et al. 2016

Fortschr Röntgenstr

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“…Neurological symptoms are rare and are typically only seen when associated with mass effect-for example, in the presence of an abscess. 5,6,22 A review by Tali found the prevalence of spinal infections to be twice as high in males as females, 23 although more recent reports have not shown any major difference between sexes. Numerous risk factors are associated with spinal infections, the most common involving direct exposure of the vertebral bodies to pathogens introduced during prior surgery and trauma.…”

Section: ©Aans 2014mentioning

confidence: 99%

Computed tomography–guided percutaneous biopsy for vertebral osteomyelitis: a department's experience

Garg

Kosmas

Young

et al. 2014

FOC

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Object Vertebral osteomyelitis has been reported to occur in approximately 0.2–2 cases per 100,000 annually. Elevated laboratory values such as erythrocyte sedimentation rate and C-reactive protein suggest inflammatory etiologies. Different imaging modalities, from radiography and CT scanning to nuclear medicine imaging and contrastenhanced MRI, can be employed to evaluate for osteomyelitis. Although MRI has a strong sensitivity and specificity for vertebral osteomyelitis, obtaining histological and microbiological samples remains the gold standard in diagnosis. Therapy can be geared toward the specific pathogen cultured, thereby preventing the need surgical intervention in the majority of cases. However, recent reports have questioned the percentage yield of image-guided percutaneous biopsy even when there is a high clinical suspicion for vertebral osteomyelitis. Methods After obtaining institutional review board approval, the authors performed a chart review of patients who had undergone image-guided percutaneous bone biopsies at University Hospitals Case Medical Center in Cleveland, Ohio. Data were filtered for patients in whom a biopsy sample of a vertebral body/disc was obtained. A total of 213 procedures were performed, of which clinicians indicated a concern for infection in 84, infection or neoplasm in 13, and a noninfectious etiology (the majority being neoplasms) in the remaining 116. Results Histological examination provided positive results in 25 (41.0%) of the 61 samples collected for suspected cases of osteomyelitis. Microbiology samples were less predictive, with only 16 of the 84 samples collected, or 19.0%, yielding a positive result. In 10 patients there were positive blood and/or urine cultures. Of these, 8 samples (80%) demonstrated the same pathogen identified by biopsy (for the remaining 2 positive systemic cultures, no pathogen was identified by the percutaneous intervention). In other words, half of the 16 cases that provided microbiological results from biopsy demonstrated the same results by systemic cultures. However, 89 (76.7%) of the 116 samples collected with the primary concern of neoplasm yielded results. Conclusions Image-guided percutaneous biopsy for vertebral osteomyelitis demonstrates an extremely low probability of identifying specific microbes. Blood or urine cultures concurrently identified culprit pathogens in 50% of positive biopsy cultures. Therefore, in only 8 (9.5%) of 84 biopsies did the biopsy results provide additional information to clinicians as to the pathological microorganism present and how treatment might need to be adjusted.

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“…were not regarded as true pathogens, unlike in some previous studies. 11,34 This exclusion allows for a more accurate picture of the diagnostic utility of IR and surgical procedures in AHO. IR cultures were most often used in patients with disease of the pelvis, suggesting that these procedures may be particularly useful in patients with infection at sites that are difficult to access surgically.…”

Section: Figurementioning

confidence: 99%

“…34 In adults in whom there is a high suspicion of vertebral osteomyelitis, imagingguided percutaneous needle biopsy yielded a pathogen in 30.4% of cases but decreased to 5% in cases when malignancy was the initial working diagnosis in 1 study. 11 Imaging-guided aspiration/biopsy is being recognized as the standard of care in the diagnosis of vertebral osteomyelitis in adults and is currently endorsed by national guidelines. 35 Previous series in children have largely focused on the overall diagnostic yield of CT-guided musculoskeletal biopsy, including cases in which malignancy is highly suspect.…”

Section: Figurementioning

confidence: 99%

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Role of Operative or Interventional Radiology-Guided Cultures for Osteomyelitis

et al. 2016

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BACKGROUND AND OBJECTIVE: Acute hematogenous osteomyelitis (AHO) is a severe infection in children. Drainage of purulent collections in bones provides specimens for culture as well as therapeutic benefit. Interventional radiology (IR)-guided procedures may serve as a less invasive means of culture in select patients. We examined the impact of IR and surgically obtained cultures in the diagnosis and management of AHO.

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Percutaneous needle biopsy in diagnosis and identification of causative organisms in cases of suspected vertebral osteomyelitis

Cited by 109 publications

References 30 publications

CT-Guided Percutaneous Spine Biopsy in Suspected Infection or Malignancy: A Study of 214 Patients

CT-Guided Percutaneous Spine Biopsy in Suspected Infection or Malignancy: A Study of 214 Patients

Computed tomography–guided percutaneous biopsy for vertebral osteomyelitis: a department's experience

Role of Operative or Interventional Radiology-Guided Cultures for Osteomyelitis

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