Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
Skeletal Radiol. 2024 Oct;53(10):2271-2278. doi: 10.1007/s00256-024-04631-5. Epub 2024 Feb 27.
To retrospectively evaluate the correlation between intradiscal gas and infection in patients percutaneously biopsied for suspected discitis-osteomyelitis.
We retrospectively reviewed all CT-guided discitis-osteomyelitis biopsies performed between 2002 and 2022. Two independent trained musculoskeletal radiologists evaluated for presence of gas on CT and/or MRI within 1 week of the biopsy. Disagreements were resolved by a third musculoskeletal radiologist. CT was considered the gold standard for the detection of intradiscal gas. Pathology, microbiology, and imaging and clinical follow-up were used as the gold standard for presence of infection. Interrater agreement on CT and MRI, sensitivity, and positive predictive value were calculated, using the presence of gas as an indicator (test positive) for "no infection."
There were 284 biopsies in 275 subjects (mean age 58 ± 1.0 (range 4-99) years; 101 (37%) females and 174 (63%) males). Of the biopsies, 12 (4%) were cervical, 80 (28%) were thoracic, 192 (68%) were lumbar, and 200 (70%) were considered true discitis-osteomyelitis based on pathology, imaging, and clinical follow-up. Interrater agreement was excellent for CT (kappa = 0.83) and poor for MRI (kappa = - 0.021). The presence of gas had a 94% specificity and 76% negative predictive value for the absence of infection.
CT is the preferred method for detecting intradiscal gas. The presence of gas means that discitis-osteomyelitis is unlikely. If intradiscal gas is present in the setting of discitis-osteomyelitis, the gas bubbles tend to be smaller and fewer in number.
回顾性评估经皮活检疑似椎间盘炎-骨髓炎患者椎间盘内气体与感染的相关性。
我们回顾性分析了 2002 年至 2022 年间所有经 CT 引导的椎间盘炎-骨髓炎活检。两名独立的经过培训的肌肉骨骼放射科医生在活检后 1 周内评估 CT 和/或 MRI 上是否存在气体。意见分歧由第三位肌肉骨骼放射科医生解决。CT 被认为是检测椎间盘内气体的金标准。病理学、微生物学、影像学和临床随访被用作存在感染的金标准。使用气体作为“无感染”的指标（试验阳性）计算 CT 和 MRI 的组内一致性、敏感性和阳性预测值。
275 例患者中有 284 例接受了活检（平均年龄 58±1.0（范围 4-99）岁；101 例（37%）为女性，174 例（63%）为男性）。活检中，12 例（4%）为颈椎，80 例（28%）为胸椎，192 例（68%）为腰椎，200 例（70%）根据病理学、影像学和临床随访被认为是真正的椎间盘炎-骨髓炎。CT 的组内一致性很好（kappa=0.83），而 MRI 的组内一致性很差（kappa=-0.021）。存在气体对感染的阴性预测值为 94%，特异性为 76%。
CT 是检测椎间盘内气体的首选方法。存在气体意味着椎间盘炎-骨髓炎不太可能发生。如果椎间盘炎-骨髓炎中存在椎间盘内气体，那么气泡通常更小，数量更少。
