Ang Megan T, Wong Geoffrey R, Wong Davy R, Clements Warren, Joseph Tim
Department of Radiology, Alfred Hospital, Melbourne, Victoria, Australia.
Department of Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
J Med Imaging Radiat Oncol. 2019 Oct;63(5):589-595. doi: 10.1111/1754-9485.12923. Epub 2019 Jul 12.
The diagnostic yield of and best approaches for imaging-guided percutaneous biopsy for vertebral osteomyelitis is controversial. Early studies suggest yields of up to 90%; however, recent evidence shows lower yields of 30-40%. We aim to determine yield and predictors of yield in percutaneous CT-guided biopsies in vertebral osteomyelitis.
We conducted a retrospective observational single-centre study cohort study of all patients presenting for vertebral biopsy or aspiration between 2014 and 2018. Only patients undergoing biopsy for suspected infection were included. Patients with malignant indications were excluded. Comprehensive review of medical records was performed for clinical presentation, comorbidities, imaging, biomarkers, microbiology and treatment.
Overall, 40 out of 88 biopsies were performed for suspected infection, in 36 patients. Mean age was 59 ± 18 years; 29 (81%) were male. Of the 40 samples, an organism was identified in 14 samples (35%). Gram-positive organisms were most commonly identified; Staphylococcus aureus was cultured in 7 (50%) of samples. Mean admission CRP was significantly higher in patients with identified organisms compared to those without (137 ± 106 vs 54 ± 78, P = 0.008). Aspiration was a strong independent predictor of positive microbiological growth on multivariate analysis (OR 6.52 [1.25-34.02], P = 0.026). Biopsy or aspiration aided clinical decision-making in half of cases.
Percutaneous CT-guided biopsy has a modest yield for identifying the culprit organism in suspected cases of vertebral osteomyelitis. Elevated CRP and aspiration of fluid collections are associated with improved microbiological yield and should be considered in deciding when and where to biopsy.
影像引导下经皮穿刺活检对椎体骨髓炎的诊断率及最佳方法存在争议。早期研究表明诊断率高达90%；然而，近期证据显示诊断率较低，为30%-40%。我们旨在确定经皮CT引导下椎体骨髓炎穿刺活检的诊断率及诊断率的预测因素。
我们对2014年至2018年间所有因椎体活检或穿刺就诊的患者进行了一项回顾性观察单中心队列研究。仅纳入因疑似感染而接受活检的患者。排除有恶性指征的患者。对病历进行全面回顾，包括临床表现、合并症、影像学、生物标志物、微生物学及治疗情况。
总体而言，88例活检中有40例是针对疑似感染进行的，涉及36例患者。平均年龄为59±18岁；29例（81%）为男性。在40份样本中，14份样本（35%）鉴定出病原体。最常鉴定出革兰氏阳性菌；7份样本（50%）培养出金黄色葡萄球菌。与未鉴定出病原体的患者相比，鉴定出病原体的患者入院时平均C反应蛋白水平显著更高（137±106 vs 54±78，P=0.008）。在多变量分析中，穿刺是微生物学阳性生长的有力独立预测因素（比值比6.52[1.25-34.02]，P=0.026）。活检或穿刺在半数病例中有助于临床决策。
在疑似椎体骨髓炎病例中，经皮CT引导下活检对确定病原体的诊断率适中。C反应蛋白升高及抽取积液与提高微生物学诊断率相关，在决定何时及何处进行活检时应予以考虑。
