Can gas and infection coexist in the intervertebral disc? A retrospective analysis of percutaneously biopsied suspected discitis-osteomyelitis cases.

Autor: Husseini JS; Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA., Hanly A; Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA., Omeroglu E; Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA., Nelson SB; Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA., Jesse MK; Department of Radiology, University of Colorado, Aurora, CO, USA., Simeone FJ; Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA., Chang CY; Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA. cychang@mgh.harvard.edu.
Jazyk: angličtina
Zdroj: Skeletal radiology [Skeletal Radiol] 2024 Oct; Vol. 53 (10), pp. 2271-2278. Date of Electronic Publication: 2024 Feb 27.
DOI: 10.1007/s00256-024-04631-5
Abstrakt: Objectives: To retrospectively evaluate the correlation between intradiscal gas and infection in patients percutaneously biopsied for suspected discitis-osteomyelitis.
Materials and Methods: 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."
Results: 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.
Conclusion: 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.
(© 2024. The Author(s), under exclusive licence to International Skeletal Society (ISS).)
Databáze: MEDLINE
Externí odkaz: