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Chotard E, Jacquier H, Bart G, et al. MRI Features Associated With the Detection of Microbial Pathogens by CT-Guided Biopsy in Septic Spondylodiscitis. J Clin Rheumatol. 2022;28(1):e189-e194doi: 10.1097/RHU.0000000000001683.
Chotard, E., Jacquier, H., Bart, G., Richette, P., Rioux, C., Joly, V., Goossens, J., Palazzo, E., Forien, M., Jelin, G., Yazdanpanah, Y., Dieudé, P., Le Goff, B., & Ottaviani, S. (2022). MRI Features Associated With the Detection of Microbial Pathogens by CT-Guided Biopsy in Septic Spondylodiscitis. Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases, 28(1), e189-e194. https://doi.org/10.1097/RHU.0000000000001683
Chotard, Emilie, et al. "MRI Features Associated With the Detection of Microbial Pathogens by CT-Guided Biopsy in Septic Spondylodiscitis." Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases vol. 28,1 (2022): e189-e194. doi: https://doi.org/10.1097/RHU.0000000000001683
Chotard E, Jacquier H, Bart G, Richette P, Rioux C, Joly V, Goossens J, Palazzo E, Forien M, Jelin G, Yazdanpanah Y, Dieudé P, Le Goff B, Ottaviani S. MRI Features Associated With the Detection of Microbial Pathogens by CT-Guided Biopsy in Septic Spondylodiscitis. J Clin Rheumatol. 2022 Jan 01;28(1):e189-e194. doi: 10.1097/RHU.0000000000001683. PMID: 33337806.
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J Clin Rheumatol. 2022 Jan 01;28(1):e189-e194. doi: 10.1097/RHU.0000000000001683.

MRI Features Associated With the Detection of Microbial Pathogens by CT-Guided Biopsy in Septic Spondylodiscitis.

Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases

Emilie Chotard, Hervé Jacquier, Géraldine Bart, Pascal Richette, Christophe Rioux, Véronique Joly, Julia Goossens, Elisabeth Palazzo, Marine Forien, Germain Jelin, Yazdan Yazdanpanah, Philippe Dieudé, Benoît Le Goff, Sébastien Ottaviani

Affiliations

  1. From the Rheumatology Department, DHU FIRE, Pôle Infection Immunité, Bichat Hospital (AP-HP).
  2. Microbiology Department, Lariboisière Hospital, Paris.
  3. Rheumatology Department, Hôtel Dieu Hospital, Nantes.
  4. Rheumatology Department, Centre Viggo Petersen, Pole Appareil Locomoteur, Lariboisière Hospital (AP-HP), Inserm UMR 1132, USPC.
  5. Infectious and Tropical Diseases Department, Bichat Hospital, Paris, France.

PMID: 33337806 DOI: 10.1097/RHU.0000000000001683

Abstract

OBJECTIVE: The aim of this study was to assess the magnetic resonance imaging (MRI) features associated with microbial pathogen detection by computed tomography (CT)-guided biopsy in patients with suspected septic spondylodiscitis.

METHODS: For the last 10-year period, we analyzed the medical records of patients who underwent MRI and CT-guided biopsy for suspected septic spondylodiscitis. Clinical characteristics were recorded. The following MRI features were assessed: edema or contrast enhancement of the intervertebral disc, adjacent vertebrae, epidural and paravertebral space, presence of abscess, and paravertebral edema size. A positive biopsy was defined by pathogen identification on bacterial analysis or the presence of granuloma on histology. Predictors of a positive biopsy were assessed with a logistic regression model.

RESULTS: We examined data for 61 patients (34 [56%] male; mean age, 59.9 ± 18.0 years); for 35 patients (57%), CT-guided biopsy was positive for a pathogen. The 4 MRI findings significantly associated with a positive biopsy were epiduritis, greater than 50% vertebral endplate edema, loss of intradiscal cleft, and abscess. The size of paravertebral edema was greater with a positive than negative biopsy (median, 15.9 [interquartile range, 11.3-21.3] vs 7.3 [4.6-12.9] mm; p = 0.004). On multivariable analysis, epiduritis was the only independent predictor of a positive biopsy (adjusted odds ratio, 7.4 [95% confidence interval, 1.7-31.4]; p = 0.006).

CONCLUSIONS: Epiduritis and the size of paravertebral edema on MRI are associated with detection of a microbial pathogen in suspected septic spondylodiscitis. For patients without these MRI signs, the need for further investigations such as enriched or prolonged cultures, a second CT-guided biopsy, or even surgical biopsy need to be discussed.

Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

Conflict of interest statement

The authors declare no conflict of interest.

References

  1. Cottle L, Riordan T. Infectious spondylodiscitis. J Infect. 2008;56:401–412. - PubMed
  2. Pola E, Taccari F, Autore G, et al. Multidisciplinary management of pyogenic spondylodiscitis: epidemiological and clinical features, prognostic factors and long-term outcomes in 207 patients. Eur Spine J. 2018;27:229–236. - PubMed
  3. Ponciano A, Cruz G, Ventura C, et al. Infectious spondylodiscitis: 5-year analysis of a tertiary hospital in Portugal. Infect Dis (Lond). 2018;50:637–639. - PubMed
  4. Raghavan M, Lazzeri E, Palestro CJ. Imaging of spondylodiscitis. Semin Nucl Med. 2018;48:131–147. - PubMed
  5. Sheikh AF, Khosravi AD, Goodarzi H, et al. Pathogen identification in suspected cases of pyogenic spondylodiscitis. Front Cell Infect Microbiol. 2017;7:60. - PubMed
  6. Spira D, Germann T, Lehner B, et al. CT-guided biopsy in suspected spondylodiscitis—the association of paravertebral inflammation with microbial pathogen detection. PloS One. 2016;11:e0146399. - PubMed
  7. Kumar Y, Gupta N, Chhabra A, et al. Magnetic resonance imaging of bacterial and tuberculous spondylodiscitis with associated complications and non-infectious spinal pathology mimicking infections: a pictorial review. BMC Musculoskelet Disord. 2017;18:244. - PubMed
  8. Snijders GF, Schipper LG, Masteling-Slaats MG, et al. Spondylodiscitis as a rare manifestation of gout [in Dutch]. Ned Tijdschr Geneeskd. 2017;161:D1898. - PubMed
  9. Moshrif A, Laredo JD, Bassiouni H, et al. Spinal involvement with calcium pyrophosphate deposition disease in an academic rheumatology center: a series of 37 patients. Semin Arthritis Rheum. 2019;48:1113–1126. - PubMed
  10. Morales H. Infectious spondylitis mimics: mechanisms of disease and imaging findings. Semin Ultrasound CT MR. 2018;39:587–604. - PubMed
  11. Kuo G, Sun WC, Lu YA, et al. Chronic dialysis patients with infectious spondylodiscitis have poorer outcomes than non-dialysis populations. Ther Clin Risk Manag. 2018;14:257–263. - PubMed
  12. McNamara AL, Dickerson EC, Gomez-Hassan DM, et al. Yield of image-guided needle biopsy for infectious discitis: a systematic review and meta-analysis. AJNR Am J Neuroradiol. 2017;38:2021–2027. - PubMed
  13. Brinjikji W, Everist BM, Wald JT, et al. Association between imaging findings and microbiological findings for image‐guided biopsies for spine infections. J Neurosurg Sci. 2017;61:589–596. - PubMed
  14. Ahuja N, Sharma H. The effectiveness of computed tomography-guided biopsy for the diagnosis of spondylodiscitis: an analysis of variables affecting the outcome. Eur Rev Med Pharmacol Sci. 2017;21:2021–2026. - PubMed
  15. Yeom JA, Lee IS, Suh HB, et al. Magnetic resonance imaging findings of early spondylodiscitis: interpretive challenges and atypical findings. Korean J Radiol. 2016;17:565–580. - PubMed
  16. Grammatico L, Baron S, Rusch E, et al. Epidemiology of vertebral osteomyelitis (VO) in France: analysis of hospital-discharge data 2002–2003. Epidemiol Infect. 2008;136:653–660. - PubMed
  17. Chong BSW, Brereton CJ, Gordon A, et al. Epidemiology, microbiological diagnosis, and clinical outcomes in pyogenic vertebral osteomyelitis: a 10-year retrospective cohort study. Open Forum Infect Dis. 2018;5:ofy037. - PubMed
  18. Lora-Tamayo J, Euba G, Narváez JA, et al. Changing trends in the epidemiology of pyogenic vertebral osteomyelitis: the impact of cases with no microbiologic diagnosis. Semin Arthritis Rheum. 2011;41:247–255. - PubMed
  19. Pandita N, Paul S, Yadav G, et al. Evaluation of challenges in diagnosis of spontaneous subacute pyogenic spondylodiscitis in immunocompetent patients: experiences from a tertiary care center. Asian Spine J. 2019;13:621–629. - PubMed
  20. Özmen D, Özkan N, Guberina N, et al. Computed-tomography-guided biopsy in suspected spondylodiscitis: single-center experience including 201 biopsy procedures. Orthop Rev (Pavia). 2019;11:7793. - PubMed
  21. Sertic M, Parkes L, Mattiassi S, et al. The efficacy of computed tomography-guided percutaneous spine biopsies in determining a causative organism in cases of suspected infection: a systematic review. Can Assoc Radiol J. 2019;70:96–103. - PubMed
  22. Foreman SC, Schwaiger BJ, Gempt J, et al. MR and CT imaging to optimize CT-guided biopsies in suspected spondylodiscitis. World Neurosurg. 2017;99:726–734.e7. - PubMed
  23. Friedman JA, Maher CO, Quast LM, et al. Spontaneous disc space infections in adults. Surg Neurol. 2002;57:81–86. - PubMed
  24. Gouliouris T, Aliyu SH, Brown NM. Spondylodiscitis: update on diagnosis and management. J Antimicrob Chemother. 2010;65(Suppl 3):iii11–iii24. - PubMed
  25. Czuczman GJ, Marrero DE, Huang AJ, et al. Diagnostic yield of repeat CT-guided biopsy for suspected infectious spondylodiscitis. Skeletal Radiol. 2018;47:1403. - PubMed
  26. Choi S-H, Sung H, Kim S-H, et al. Usefulness of a direct 16S rRNA gene PCR assay of percutaneous biopsies or aspirates for etiological diagnosis of vertebral osteomyelitis. Diagn Microbiol Infect Dis. 2014;78:75–78. - PubMed

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