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Laur O, Schonberger A, Gunio D, Minkowitz S, Salama G, Burke CJ, Bartolotta RJ. Imaging assessment of spine infection. Skeletal Radiol 2024; 53:2067-2079. [PMID: 38228784 DOI: 10.1007/s00256-023-04558-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/04/2023] [Accepted: 12/21/2023] [Indexed: 01/18/2024]
Abstract
This article comprehensively reviews current imaging concepts in spinal infection with primary focus on infectious spondylodiscitis (IS) as well as the less common entity of facet joint septic arthritis (FSA). This review encompasses the multimodality imaging appearances (radiographs, CT, MRI, and nuclear imaging) of spinal infection-both at initial presentation and during treatment-to aid the radiologist in guiding diagnosis and successful management. We discuss the pathophysiology of spinal infection in various patient populations (including the non-instrumented and postoperative spine) as well as the role of imaging-guided biopsy. We also highlight several non-infectious entities that can mimic IS (both clinically and radiologically) that should be considered during image interpretation to avoid misdiagnosis. These potential mimics include the following: Modic type 1 degenerative changes, acute Schmorl's node, neuropathic spondyloarthropathy, radiation osteitis, and inflammatory spondyloarthropathy (SAPHO syndrome).
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Affiliation(s)
- Olga Laur
- Department of Radiology, Division of Musculoskeletal Radiology, NewYork-Presbyterian Hospital, Weill Cornell Medicine, 525 East 68th Street, New York, NY, 10065, USA.
| | - Alison Schonberger
- Department of Radiology, Division of Musculoskeletal Radiology, NewYork-Presbyterian Hospital, Weill Cornell Medicine, 525 East 68th Street, New York, NY, 10065, USA
| | - Drew Gunio
- Department of Radiology, Division of Musculoskeletal Radiology, NewYork-Presbyterian Hospital, Weill Cornell Medicine, 525 East 68th Street, New York, NY, 10065, USA
| | - Shlomo Minkowitz
- Department of Radiology, Division of Neuroradiology, NewYork-Presbyterian Hospital, Weill Cornell Medicine, 525 East 68th Street, New York, NY, 10065, USA
| | - Gayle Salama
- Department of Radiology, Division of Neuroradiology, NewYork-Presbyterian Hospital, Weill Cornell Medicine, 525 East 68th Street, New York, NY, 10065, USA
| | - Christopher J Burke
- Department of Radiology, Division of Musculoskeletal Imaging, New York University School of Medicine, Center for Biomedical Imaging, 660 First Ave, New York, NY, 10016, USA
| | - Roger J Bartolotta
- Department of Radiology, Division of Musculoskeletal Radiology, NewYork-Presbyterian Hospital, Weill Cornell Medicine, 525 East 68th Street, New York, NY, 10065, USA
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Peel TN, Cherk M, Yap K. Imaging in osteoarticular infection in adults. Clin Microbiol Infect 2024; 30:312-319. [PMID: 37940000 DOI: 10.1016/j.cmi.2023.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/18/2023] [Accepted: 11/02/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Osteoarticular infections are uncommon and required a multimodal approach for diagnosis. Imaging forms an important component of this multimodal approach. OBJECTIVES In this narrative review, we describe the different imaging modalities, features of osteoarticular infections present on these imaging approaches and recommendations for which imaging modality should be considered in different types of osteoarticular infections. SOURCES This narrative review was based on literature review from PubMed and was limited to bacterial infections in adult patients. CONTENT Imaging modalities include modalities that provide information on the anatomy or radionuclide imaging that provides information about the metabolic activity of the area of interest. Anatomical imaging includes plain radiographs (X-ray), computed tomography, and magnetic resonance imaging. Radionuclide approaches include three-phase bone scintigraphy, gallium scans, white blood cell scintigraphy, and 18F-fluorodeoxy-glucose positron emission tomography. The optimal radiological modality for diagnosis is influenced by multiple factors, including infection location, presence of metalware, timing of infection from any preceding surgery or fracture, antibiotic use, and patient comorbidities. Local availability of scanning modality, tracer supply, technical expertise, and patient access also influences choice. IMPLICATIONS A collaborative approach with imaging, pathology and clinical input in a multidisciplinary setting is paramount for the diagnosis of osteoarticular infections. Increasing research and improvements in technology will further improve the utility and accuracy of imaging approaches for imaging in osteoarticular infections.
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Affiliation(s)
- Trisha N Peel
- Department of Infectious Diseases, Monash University and Alfred Health, Melbourne, VIC, Australia.
| | - Martin Cherk
- Department of Nuclear Medicine & PET, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Kenneth Yap
- Department of Nuclear Medicine & PET, Alfred Health, Melbourne, VIC, Australia; Central Clinical School, Monash University, Melbourne, VIC, Australia
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Dayer R, De Marco G, Vazquez O, Tabard-Fougère A, Cochard B, Gavira N, Di Laura Frattura G, Guanziroli Pralong N, Steiger C, Ceroni D. Laboratory diagnostics for primary spinal infections in pediatric and adult populations: a narrative review. NORTH AMERICAN SPINE SOCIETY JOURNAL 2023; 16:100270. [PMID: 37767011 PMCID: PMC10520565 DOI: 10.1016/j.xnsj.2023.100270] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 08/02/2023] [Accepted: 08/18/2023] [Indexed: 09/29/2023]
Abstract
Primary spinal infection (PSI) is a generic term covering a heterogeneous group of infections that can affect the vertebral body, intervertebral disks, the content of the medullary cavity, and adjacent paraspinal tissues. Patients' characteristics can vary significantly, notably according to their age, and some of these characteristics undoubtedly play a primordial role in the occurrence of a PSI and in the type of offending pathogen. Before approaching the subject of laboratory diagnostics, it is essential to define the characteristics of the patient and their infection, which can then guide the physician toward specific diagnostic approaches. This review critically examined the roles and usefulness of traditional and modern laboratory diagnostics in supporting clinicians' decision-making in cases of pediatric and adult primary spinal infection (PSI). It appears impossible to compare PSIs in children and adults, whether from an epidemiological, clinical, bacteriological, or biological perspective. The recipients are really too different, and the responsible germs are closely correlated to their age. Secondly, the interpretation of traditional laboratory blood tests appears to contribute little guidance for clinicians attempting to diagnose a PSI. Biopsy or needle aspiration for bacterial identification remains a controversial subject, as the success rates of these procedures for identifying causative organisms are relatively uncertain in pediatric populations.Using nucleic acid amplification assays (NAAAs) on biopsy samples has been demonstrated to be more sensitive than conventional cultures for diagnosing PSI. Recent advances in next-generation sequencing (NGS) are particularly interesting for establishing a microbiological diagnosis of a PSI when standard cultures and NAAAs have failed to detect the culprit. We can even imagine that plasma metagenomic NGS using plasma (known as "liquid biopsy") is a diagnostic approach that can detect not only pathogens circulating in the bloodstream but also those causing focal infections, and thus eliminate the need for source sample collection using costly invasive surgical procedures.
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Affiliation(s)
- Romain Dayer
- Pediatric Orthopedics Unit, Pediatric Surgery Service, Geneva University Hospitals and University of Geneva Rue Willy-Donzé 6, Geneva 1205, Switzerland
| | - Giacomo De Marco
- Pediatric Orthopedics Unit, Pediatric Surgery Service, Geneva University Hospitals and University of Geneva Rue Willy-Donzé 6, Geneva 1205, Switzerland
| | - Oscar Vazquez
- Pediatric Orthopedics Unit, Pediatric Surgery Service, Geneva University Hospitals and University of Geneva Rue Willy-Donzé 6, Geneva 1205, Switzerland
| | - Anne Tabard-Fougère
- Pediatric Orthopedics Unit, Pediatric Surgery Service, Geneva University Hospitals and University of Geneva Rue Willy-Donzé 6, Geneva 1205, Switzerland
| | - Blaise Cochard
- Pediatric Orthopedics Unit, Pediatric Surgery Service, Geneva University Hospitals and University of Geneva Rue Willy-Donzé 6, Geneva 1205, Switzerland
| | - Nathaly Gavira
- Pediatric Orthopedics Unit, Pediatric Surgery Service, Geneva University Hospitals and University of Geneva Rue Willy-Donzé 6, Geneva 1205, Switzerland
| | - Giorgio Di Laura Frattura
- Pediatric Orthopedics Unit, Pediatric Surgery Service, Geneva University Hospitals and University of Geneva Rue Willy-Donzé 6, Geneva 1205, Switzerland
| | - Nastassia Guanziroli Pralong
- Pediatric Orthopedics Unit, Pediatric Surgery Service, Geneva University Hospitals and University of Geneva Rue Willy-Donzé 6, Geneva 1205, Switzerland
| | - Christina Steiger
- Pediatric Orthopedics Unit, Pediatric Surgery Service, Geneva University Hospitals and University of Geneva Rue Willy-Donzé 6, Geneva 1205, Switzerland
| | - Dimitri Ceroni
- Pediatric Orthopedics Unit, Pediatric Surgery Service, Geneva University Hospitals and University of Geneva Rue Willy-Donzé 6, Geneva 1205, Switzerland
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Cahalane AM, Habib U, Balza R, Husseini JS, Simeone FJ, Lozano-Calderon S, Chang CY. A novel core biopsy needle with shorter dead space for percutaneous image-guided musculoskeletal biopsies - how does it compare with an established core biopsy needle? Skeletal Radiol 2023; 52:99-109. [PMID: 35876864 DOI: 10.1007/s00256-022-04130-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 07/16/2022] [Accepted: 07/17/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare diagnostic yield and utility of a novel core biopsy needle (NCBN) with shortened tip dead space for percutaneous musculoskeletal biopsies with an established core biopsy needle (ECBN). METHODS This study was IRB approved and HIPAA compliant. All percutaneous biopsies using an NCBN performed between July 2020 and August 2021 were retrospectively reviewed. Data on patient demographics, biopsy technique, biopsy needle, and histopathology were collated. RESULTS Thirty-six patients were included in this study, 16 (44%) undergoing biopsy with both an NCBN and an ECBN, and 20 (56%) with an NCBN only. All 36 NCBN biopsies were 16 gauge. Fifteen (94%) of the ECBN biopsies were 14 gauge, and 1 (6%) was 16 gauge. Thirty-four (94%) of the NCBN and 15 (94%) of the ECBN biopsies were diagnostic. No adverse events were identified. CONCLUSION Both the NCBN and ECBN have high diagnostic rates. No adverse events were identified. NCBN could be considered for biopsy of lesions limited by anatomic location or near adjacent critical structures.
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Affiliation(s)
- Alexis M Cahalane
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Yawkey 6E, 55 Fruit Street, Boston, MA, 02114, USA
| | - Ukasha Habib
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Yawkey 6E, 55 Fruit Street, Boston, MA, 02114, USA
| | - Rene Balza
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Yawkey 6E, 55 Fruit Street, Boston, MA, 02114, USA
| | - Jad S Husseini
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Yawkey 6E, 55 Fruit Street, Boston, MA, 02114, USA
| | - F Joseph Simeone
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Yawkey 6E, 55 Fruit Street, Boston, MA, 02114, USA
| | - Santiago Lozano-Calderon
- Department of Orthopedics, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Connie Y Chang
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Yawkey 6E, 55 Fruit Street, Boston, MA, 02114, USA.
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Maamari JB, Tande AJ, Tai DBG, Diehn FE, Ross C, Lahr B, Suh GA, Berbari EF. Factors Impacting the Yield of Image-Guided Biopsy in Native Vertebral Osteomyelitis: A 10-Year Retrospective Study. Open Forum Infect Dis 2022; 9:ofac616. [PMID: 36570966 PMCID: PMC9772870 DOI: 10.1093/ofid/ofac616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 11/04/2022] [Indexed: 11/18/2022] Open
Abstract
Background Image-guided biopsies in patients with suspected native vertebral osteomyelitis (NVO) are recommended to establish the microbiological diagnosis and guide antibiotic therapy. Despite recent advances, the microbiological yield of this procedure remains between 48% and 52%. A better understanding of factors associated with this low yield may lead to improved microbiological diagnosis. Methods We retrospectively identified patients with suspected NVO undergoing image-guided biopsies from January 2011 to June 2021 at our institution. Two hundred nine patients undergoing 248 percutaneous biopsies were included. Demographic data, biopsy and microbiologic techniques, clinical characteristics, and antibiotic use were collected. Multivariable logistic regression analysis was conducted to determine factors associated with microbiological yield. Results A total of 110 of 209 (52.6%) initial image-guided biopsies revealed positive microbiological results. This number increased to 121 of 209 (57.9%) when repeat image-guided biopsies were included. In multivariable analysis, aspiration of fluid was associated with a 3-fold increased odds of yielding a positive result (odds ratio [OR], 3.13; 95% confidence interval [CI], 1.39-7.04; P = .006), whereas prior antibiotic use was associated with a 3-fold decreased yield (OR, 0.32; 95% CI, .16-.65; P = .002). A univariate subgroup analysis revealed a significant association between the length of the antibiotic-free period and microbiological yield, with the lowest rates of pathogen detection at 0-3 days and higher rates as duration increased (P = .017). Conclusions Prior antibiotic use in patients with suspected NVO was associated with a decrease in the microbiological yield of image-guided biopsies. An antibiotic-free period of at least 4 days is suggested to maximize yield. Successful fluid aspiration during the procedure also increases microbiological yield.
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Affiliation(s)
- Julian B Maamari
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Minneapolis, Minnesota, USA
| | - Aaron J Tande
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Minneapolis, Minnesota, USA
| | - Don Bambino Geno Tai
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Minneapolis, Minnesota, USA,Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Felix E Diehn
- Department of Radiology, Mayo Clinic, Minneapolis, Minnesota, USA
| | - Courtney Ross
- Department of Radiology, Mayo Clinic, Minneapolis, Minnesota, USA
| | - Brian Lahr
- Department of Quantitative Health Sciences, Mayo Clinic, Minneapolis, Minnesota, USA
| | - Gina A Suh
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Minneapolis, Minnesota, USA
| | - Elie F Berbari
- Correspondence: Elie F. Berbari, MD, Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine, 200 1st St. SW, Rochester, MN 55905 ()
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Role of CT and MR imaging in the assessment of suspected spondylodiscitis and planning of needle biopsy. Radiol Med 2022; 127:1023-1031. [DOI: 10.1007/s11547-022-01523-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 06/27/2022] [Indexed: 11/26/2022]
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Maamari J, Tande A, Diehn F, Tai DBG, Berbari E. Diagnosis of vertebral osteomyelitis. J Bone Jt Infect 2022; 7:23-32. [PMID: 35136714 PMCID: PMC8814828 DOI: 10.5194/jbji-7-23-2022] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 01/06/2022] [Indexed: 12/19/2022] Open
Abstract
Native vertebral osteomyelitis (NVO) is a potentially fatal infection which
has seen a gradual increase in its incidence over the past decades. The
infection is insidious, presenting with symptoms of back pain. Fever is
present in about 60 % of patients. Prompt diagnosis of NVO is important to
prevent the development of complications. Numerous laboratory and imaging
tools can be deployed to accurately establish the diagnosis. Imaging
techniques such as magnetic resonance, nuclear imaging, and computed
tomography are essential in diagnosing NVO but can also be useful in
image-guided biopsies. Laboratory tools include routine blood tests,
inflammatory markers, and routine culture techniques of aspirated specimens.
Recent advances in molecular techniques can assist in identifying offending
pathogen(s). In this review, we detail the arsenal of techniques that can be
utilized to reach a diagnosis of NVO.
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Affiliation(s)
- Julian Maamari
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA
| | - Aaron J. Tande
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA
| | - Felix Diehn
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Elie F. Berbari
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA
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Cannavale A, Nardis P, Lucatelli P, Corona M, Santoni M, Cannavale G, Teodoli L, Bezzi M, Catalano C. Percutaneous spine biopsy under cone beam computed tomography guidance for spondylodiscitis: Time is diagnosis. Neuroradiol J 2021; 34:607-614. [PMID: 34028300 PMCID: PMC8649179 DOI: 10.1177/19714009211017799] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND PURPOSE Percutaneous spine biopsies for spondylodiscitis have been long discussed due to the low microbiologic yield. This retrospective study evaluated factors of cone beam computed tomography-guided spine biopsies that may affect microbiologic yield. METHODS We retrospectively reviewed percutaneous spine biopsies under cone beam computed tomography for spondylodiscitis performed from January 2015-December 2020. Clinical and technical features such as the time from initial symptoms to biopsy, level biopsied, biopsy needle type/gauge, technical approach, radiation dose, technical success and microbiologic yield were recorded. Pre-procedure magnetic resonance imaging findings were also recorded such as the number of vertebral bodies involved, and disc morphology. Univariate logistic regression analysis and Receiver operating characteristic analysis were performed to assess any relationship between relevant factors and positive cultures. RESULTS A total of 50 patients underwent cone beam computed tomography-guided biopsies for spondylodiscitis, with resulted positive cultures in 18 patients (36%). The mean time from the initial referral of spinal symptoms to procedure in the positive culture group was the most influential finding for positive cultures (odds ratio 56.3, p < 0.001). Among magnetic resonance imaging findings, thin or degenerated intervertebral disc was a negative factor for positive cultures (odds ratio 0.09, p = 0.006). Univariate analysis showed that percutaneous approach (transpedicular vs posterolateral/interlaminar) needle size (11-13 g vs 16-18G, odds ratio 1.2, p = 0.7) and site of biopsy (disc vs bone vs disc plus endplate) did not significantly affect the microbiologic yield of spine biopsy. CONCLUSION Percutaneous cone beam computed tomography-guided biopsy for spondylodiscitis is a reliable and safe technique and its microbiologic yield may increase if biopsy is performed within the acute phase of infection.
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Affiliation(s)
| | - Piergiorgio Nardis
- Department of Radiological Sciences, Umberto I Policlinico di Roma, Italy
| | | | - Mario Corona
- Department of Radiological Sciences, Umberto I Policlinico di Roma, Italy
| | - Mariangela Santoni
- Department of Radiological Sciences, Umberto I Policlinico di Roma, Italy
| | - Giuseppe Cannavale
- Department of Radiological Sciences, Umberto I Policlinico di Roma, Italy
| | - Leonardo Teodoli
- Department of Radiological Sciences, Umberto I Policlinico di Roma, Italy
| | - Mario Bezzi
- Department of Radiological Sciences, Umberto I Policlinico di Roma, Italy
| | - Carlo Catalano
- Department of Radiological Sciences, Umberto I Policlinico di Roma, Italy
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Best Practices: CT-Guided Percutaneous Sampling of Vertebral Discitis-Osteomyelitis and Technical Factors Maximizing Biopsy Yield. AJR Am J Roentgenol 2021; 217:1057-1068. [PMID: 33336581 DOI: 10.2214/ajr.20.24313] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Vertebral discitis-osteomyelitis is an infection of the intervertebral disk and vertebral bodies that may extend to adjacent paraspinal and epidural soft tissues. Its incidence is increasing, likely because of improved treatments and increased life expectancy for patients with predisposing chronic disease and increased rates of IV drug use and intravascular intervention. Because blood cultures are frequently negative in patients with vertebral discitis-osteomyelitis, biopsy is often indicated to identify a causative microorganism for targeted antimicrobial therapy. The reported yield of CT-guided percutaneous sampling is 31-91%, which is lower than the reported yield of open biopsy of 76-91%. However, the less invasive approach may be favored given its relative safety and low cost. If paravertebral fluid collections are present, CT-guided aspiration should be performed. If aspiration is unsuccessful or no paravertebral fluid collections are present, CT-guided percutaneous biopsy should be performed, considering technical factors (e.g., anatomic approach, needle selection, and needle angulation) that may improve microbiologic yield. Although antimicrobial therapy should be withheld for 1-2 weeks before biopsy if clinically feasible, biopsy may still be performed without stopping antimicrobial therapy if needed. Because of the importance of targeted antimicrobial therapy, repeat biopsy should be considered after 72 hours if initial biopsy does not identify a pathogen.
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Review article: the current status of CT-guided needle biopsy of the spine. Skeletal Radiol 2021; 50:281-299. [PMID: 32815040 DOI: 10.1007/s00256-020-03584-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/12/2020] [Accepted: 08/12/2020] [Indexed: 02/02/2023]
Abstract
CT-guided percutaneous needle biopsy of the spine is a well-described technique for determining the nature of indeterminate vertebral lesions or establishing a diagnosis of spinal infection, the high diagnostic accuracy and the safety of the procedure having been extensively documented. The purpose of the current article is to review the literature to date on CT-guided spinal biopsy. Specifically, indications for spinal biopsy, techniques for optimising yield, detail of the approaches for various spinal levels which is dependent upon both the region within the spinal column and lesion location within the vertebra (body vs. neural arch), determinants of biopsy outcome and complications are covered. It is hoped that the review will be of particular benefit to junior radiologists who are required to perform this procedure.
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