Institute of Diagnostic Radiology, Interventional Radiology and Nuclear Medicine, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH, Ruhr-University of Bochum, Germany.
Eur J Radiol. 2012 Mar;81(3):e244-9. doi: 10.1016/j.ejrad.2011.02.007. Epub 2011 Feb 24.
To evaluate efficacy of CT-guided spinal biopsy (CTSB) in patients with spondylitis considering patient characteristics, technical issues, antibiotic therapy, histopathological, and microbiological findings.
All CTSB procedures performed between 1995 and 2009 in patients with proven spondylitis were re-evaluated. Patient sex and age, antibiotic treatment, biopsy approach, number of specimens, length of needle path, laboratory results (CRP, WBC), and histopathological/microbiological findings were documented and compared to the final diagnosis of spondylitis. Statistical analysis was performed using Chi-square test and Student's t-test. The p-value was set to 5%.
164 CTSB procedures were performed in 159 patients (mean age 65 years, 60% men) in which spondylitis was histopathologically verified in 95%. Neither patient sex nor age, positioning, localization of the spinal lesion, bioptic approach, number of specimens, or depth of the needle showed significant impact on the rate of positive histopathological findings. A causative germ was identified in 40/127 biopsies (32%) with Staphylococcus aureus being identified in 50%. Tuberculous spondylitis was diagnosed in ten cases (6%). CRP significantly correlated with bacterial growth (13.3±12.2 mg/dl versus 8.8±7.6 mg/dl; p=.015) whereas administration of antibiotics did not show any significant impact on bacterial growth (29% versus 36% in patients without antibiotics; p=0.428). Patients with histopathological signs of active spondylitis showed a significantly higher CRP (16.5±15.8 mg/dl versus 8.9±8.0 mg/dl, p<.001). Complication rate was 0.6% (one focal bleeding).
CTSB of the spine in suspected spondylitis is an effective and safe procedure for establishing final histopathological diagnosis. However, microbiological yield is low regardless of technical issues and antibiotic therapy. Other than CRP values, laboratory investigations added little useful information to diagnose infection in our study group. CRP values significantly correlated with bacterial growth and with histopathological signs of active spondylitis.
评估 CT 引导下脊柱活检（CTSB）在考虑患者特征、技术问题、抗生素治疗、组织病理学和微生物学发现的情况下对脊柱关节炎患者的疗效。
对 1995 年至 2009 年间在确诊脊柱关节炎患者中进行的所有 CTSB 操作进行了重新评估。记录患者的性别和年龄、抗生素治疗、活检方法、标本数量、针道长度、实验室结果（CRP、WBC）以及组织病理学/微生物学发现，并与脊柱关节炎的最终诊断进行比较。使用卡方检验和学生 t 检验进行统计学分析。p 值设置为 5%。
在 159 例患者（平均年龄 65 岁，60%为男性）中进行了 164 次 CTSB 操作，其中 95%的患者通过组织病理学证实为脊柱关节炎。患者性别和年龄、定位、脊柱病变部位、活检方法、标本数量或针的深度均未对阳性组织病理学发现率产生显著影响。在 127 例活检中，有 40 例（32%）确定了病原体，其中 50%为金黄色葡萄球菌。诊断为结核性脊柱炎 10 例（6%）。CRP 与细菌生长呈显著相关（13.3±12.2mg/dl 与 8.8±7.6mg/dl；p=.015），而抗生素的使用对细菌生长没有显著影响（无抗生素组为 29%，有抗生素组为 36%；p=0.428）。组织病理学显示有活动期脊柱关节炎迹象的患者 CRP 水平明显更高（16.5±15.8mg/dl 与 8.9±8.0mg/dl，p<.001）。并发症发生率为 0.6%（1 例局部出血）。
在疑似脊柱关节炎的患者中进行 CTSB 是一种有效且安全的方法，可获得最终的组织病理学诊断。然而，无论技术问题和抗生素治疗如何，微生物学检出率都较低。除 CRP 值外，实验室检查在本研究组中对诊断感染没有提供多少有用信息。CRP 值与细菌生长以及组织病理学上的活动期脊柱关节炎有显著相关性。
