Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street Yawkey 6E, Boston, MA, 02114, USA.
Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 20114, USA.
Skeletal Radiol. 2020 Sep;49(9):1431-1439. doi: 10.1007/s00256-020-03439-3. Epub 2020 Apr 18.
To compare the microbiology results and needle gauge for CT-guided biopsies of suspected discitis-osteomyelitis.
All CT-guided biopsies performed for suspected discitis-osteomyelitis at our institution between 2002 and 2019 were reviewed. Biopsy location, needle type and gauge, microbiology, pathology, and clinical and imaging follow-up were obtained through chart review. Yield, sensitivity, specificity, and accuracy were calculated. A pairwise analysis of different needle gauges was also performed with calculations of odds ratios. Naïve Bayes predictive modeling was performed.
241 (age: 59 ± 18 years; 88 [35%] F, 162 [65%] M) biopsies were performed. There were 3 (1%) 11 gauge (G), and 13 (5%) 12-G biopsies; 23 (10%) 13-G biopsies; 75 (31%) 14-G biopsies; and 90 (37%) 16-G, 33 (14%) 18-G, and 4 (2%) 20 G biopsies. True disease status (presence of infection) was determined via either pathology findings (205, 86%) or clinical and imaging follow-up (36, 14%). The most common true positive pathogen was Staphylococcus aureus (31, 33%). Overall biopsy yield, sensitivity, specificity, and accuracy were 39%, 56%, 89%, and 66%, respectively. Pooled biopsy yield, sensitivity, specificity, and accuracy was 56%, 69%, 71%, and 69% for 11-13-G needles and 36%, 53%, 91%, and 65% for 14-20-G needles, respectively, with an odds ratio between the two groups of 2.29 (P = 0.021). Pooled biopsy yield, sensitivity, specificity, and accuracy was 48%, 63%, 85%, and 68% for 11-14-G needles and 32%, 49%, 91%, and 64% for 16-20-G needles, respectively, with an odds ratio between the two groups of 2.02 (P = 0.0086).
The use of a larger inner bore diameter/lower gauge biopsy needle may increase the likelihood of culturing the causative microorganism for CT-guided biopsies of discitis-osteomyelitis.
比较 CT 引导下疑似椎间盘炎-骨髓炎活检的微生物学结果和针规。
回顾 2002 年至 2019 年期间在我院进行的所有疑似椎间盘炎-骨髓炎的 CT 引导下活检。通过病历回顾获取活检部位、针类型和规格、微生物学、病理学以及临床和影像学随访。计算了产量、敏感性、特异性和准确性。还对不同针规进行了配对分析，并计算了优势比。进行了朴素贝叶斯预测建模。
共进行了 241 次活检（年龄：59±18 岁；88[35%]F，162[65%]M）。有 3（1%）次 11 号（G）针和 13（5%）次 12-G 针活检；23（10%）次 13-G 针活检；75（31%）次 14-G 针活检；90（37%）次 16-G、33（14%）次 18-G 和 4（2%）次 20-G 针活检。通过病理学发现（205，86%）或临床和影像学随访（36，14%）确定真正的疾病状态（存在感染）。最常见的真阳性病原体是金黄色葡萄球菌（31，33%）。总体活检产量、敏感性、特异性和准确性分别为 39%、56%、89%和 66%。11-13-G 针的 pooled 活检产量、敏感性、特异性和准确性分别为 56%、69%、71%和 69%，14-20-G 针的 pooled 活检产量、敏感性、特异性和准确性分别为 36%、53%、91%和 65%，两组之间的优势比为 2.29（P=0.021）。11-14-G 针的 pooled 活检产量、敏感性、特异性和准确性分别为 48%、63%、85%和 68%，16-20-G 针的 pooled 活检产量、敏感性、特异性和准确性分别为 32%、49%、91%和 64%，两组之间的优势比为 2.02（P=0.0086）。
对于 CT 引导下的椎间盘炎-骨髓炎活检，使用更大的内孔直径/较低规格的活检针可能会增加培养致病微生物的可能性。
