Baxi Sanjiv, Malani Preeti N, Gomez-Hassan Diana, Cinti Sandro K
Department of Internal Medicine, University of California San Francisco, San Francisco, CA.
Division of Geriatric Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI ; Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI ; Geriatric Research, Education, and Clinical Center (GRECC), Ann Arbor, MI ; Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI.
Infect Dis Clin Pract (Baltim Md). 2012 Sep 1;20(5):326-329. doi: 10.1097/IPC.0b013e3182639f6a.
Spinal infections, including paraspinal and/or epidural abscesses and vertebral discitis and osteomyelitis, can have devastating consequences. The diagnostic imaging modality of choice has traditionally been magnetic resonance imaging (MRI) given the very high sensitivity and specificity, although the role of MRI in follow-up of spinal infections and how this relates to follow-up clinical status is poorly understood. We sought to understand the relationship between follow-up MRI and clinical status.
We conducted a retrospective review of adults with spinal infection to assess the relationship between follow-up MRI and clinical course. The degree of agreement between MRI and clinical follow-up was assessed using the Cohen kappa coefficient. A multinomial logistic regression model was applied to assess the impact of covariates in affecting the clinical outcome and MRI at follow-up independently.
Ninety-eight patients met inclusion criteria during a 13-year period. We observed a lack of correlation between clinical follow-up status and MRI (κ = 0.065, = 0.322). The McNemar-Bowker test for symmetry revealed that this disagreement was asymmetric ( < 0.001). Notably, clinical worsening was never associated with an improved MRI, and clinical improvement was overall not predictive of MRI result and vice versa.
Routine follow-up MRI does not seem to correlate with clinical follow-up among patients with spinal infections. The use of MRI without new clinical indications in routine follow-up testing should be interpreted with caution.
脊柱感染，包括椎旁和/或硬膜外脓肿、椎间盘炎和骨髓炎，可能会产生严重后果。鉴于磁共振成像（MRI）具有很高的敏感性和特异性，传统上它一直是首选的诊断成像方式，尽管MRI在脊柱感染随访中的作用以及它与随访临床状况的关系尚不清楚。我们试图了解随访MRI与临床状况之间的关系。
我们对患有脊柱感染的成年人进行了一项回顾性研究，以评估随访MRI与临床病程之间的关系。使用科恩kappa系数评估MRI与临床随访之间的一致性程度。应用多项逻辑回归模型独立评估协变量对随访时临床结局和MRI的影响。
在13年期间，98名患者符合纳入标准。我们观察到临床随访状态与MRI之间缺乏相关性（κ = 0.065，P = 0.322）。对称性的麦克尼马尔-鲍克检验显示这种不一致是不对称的（P < 0.001）。值得注意的是，临床恶化从未与MRI改善相关，临床改善总体上也不能预测MRI结果，反之亦然。
对于脊柱感染患者，常规随访MRI似乎与临床随访不相关。在常规随访检查中，在没有新的临床指征的情况下使用MRI应谨慎解读。
