Department of Radiological Sciences, Policlinico Umberto I, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
Department of Radiological Sciences, Policlinico Umberto I, 166 Viale del Policlinico, 00161, Rome, Italy.
Radiol Med. 2022 Sep;127(9):1023-1031. doi: 10.1007/s11547-022-01523-3. Epub 2022 Jul 30.
Our aim was to assess the role of computed tomography (CT) or magnetic resonance imaging (MRI) in the assessment of spondylodiscitis, identifying the best target structures for biopsy to increase the likelihood of positive cultures.
This study was approved by our Institutional Review Board, and requirement for specific consent form was waived. In this retrospective single Institution study, we evaluated clinical and imaging records of 60 patients who underwent spine biopsy for suspected spondylodiscitis from January 2016 to May 2021. CT and MRI sensitivity and inter-reader agreement were assessed according to the phase of spondylodiscitis, defined as acute, subacute or chronic. Inter-reader agreement for the diagnosis and identification of spondylodiscitis phase was assessed using K statistics. Univariate logistic regression analysis was performed to assess any relationship between MRI/CT findings, spondylodiscitis phase and positive cultures.
Sixty patients (48 males) with mean age 59, 2 ± 29 were enrolled in this study. MRI showed higher sensitivity (96% vs 65% of CT) in the diagnosis and good inter-reader agreement (k = 0.8) in the identification of the acute and subacute phase of spondylodiscitis, and moderate inter-reader agreement (k = 0.7) and lower sensitivity (80% vs 95% of CT) for the chronic phase. Univariate analysis showed as MRI-specific findings such as extensive hyperintensity of vertebral body and/or disc on Short Tau Inversion Recovery-T2w images, paravertebral collections, preserved or augmented disc height and presence of a vertebral fractures were mainly found in the acute/subacute phase and was a predictor for positive cultures (p < 0.05).
MRI and CT are both able to identify the different phases of spondylodiscitis, although MRI is more sensitive in the acute phase. Findings such as extensive hyperintensity of the disc/vertebral body, fractures and paravertebral collections, represent the main targets for biopsy related to a positive culture.
我们旨在评估计算机断层扫描（CT）或磁共振成像（MRI）在评估脊椎骨髓炎中的作用，确定活检的最佳靶结构，以提高阳性培养的可能性。
本研究经我院伦理审查委员会批准，豁免特定同意书要求。在这项回顾性单机构研究中，我们评估了 2016 年 1 月至 2021 年 5 月期间因疑似脊椎骨髓炎而行脊柱活检的 60 例患者的临床和影像学记录。根据脊椎骨髓炎的阶段，即急性、亚急性或慢性，评估 CT 和 MRI 的敏感性和读者间一致性。使用 K 统计评估诊断和识别脊椎骨髓炎阶段的读者间一致性。使用单变量逻辑回归分析评估 MRI/CT 结果、脊椎骨髓炎阶段和阳性培养之间的任何关系。
本研究共纳入 60 例患者（48 例男性），平均年龄为 59 岁，2 岁±29 岁。MRI 在诊断和识别急性和亚急性脊椎骨髓炎方面具有较高的敏感性（96%对 CT 的 65%），且读者间一致性良好（k=0.8），在识别慢性脊椎骨髓炎方面，读者间一致性为中等（k=0.7），敏感性较低（80%对 CT 的 95%）。单变量分析显示，MRI 特异性表现，如短反转时间反转恢复 T2w 图像上椎体和/或椎间盘广泛高信号、椎旁积液、椎间盘高度保存或增加、椎体骨折，主要见于急性/亚急性阶段，是阳性培养的预测因素（p<0.05）。
MRI 和 CT 均能识别脊椎骨髓炎的不同阶段，尽管 MRI 在急性期更敏感。广泛的椎间盘/椎体高信号、骨折和椎旁积液等表现是与阳性培养相关的活检主要靶点。
