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Crombé A, Fadli D, Clinca R, Reverchon G, Cevolani L, Girolami M, Hauger O, Matcuk GR, Spinnato P. Imaging of Spondylodiscitis: A Comprehensive Updated Review-Multimodality Imaging Findings, Differential Diagnosis, and Specific Microorganisms Detection. Microorganisms 2024; 12:893. [PMID: 38792723 PMCID: PMC11123694 DOI: 10.3390/microorganisms12050893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/11/2024] [Accepted: 04/25/2024] [Indexed: 05/26/2024] Open
Abstract
Spondylodiscitis is defined by infectious conditions involving the vertebral column. The incidence of the disease has constantly increased over the last decades. Imaging plays a key role in each phase of the disease. Indeed, radiological tools are fundamental in (i) the initial diagnostic recognition of spondylodiscitis, (ii) the differentiation against inflammatory, degenerative, or calcific etiologies, (iii) the disease staging, as well as (iv) to provide clues to orient towards the microorganisms involved. This latter aim can be achieved with a mini-invasive procedure (e.g., CT-guided biopsy) or can be non-invasively supposed by the analysis of the CT, positron emission tomography (PET) CT, or MRI features displayed. Hence, this comprehensive review aims to summarize all the multimodality imaging features of spondylodiscitis. This, with the goal of serving as a reference for Physicians (infectious disease specialists, spine surgeons, radiologists) involved in the care of these patients. Nonetheless, this review article may offer starting points for future research articles.
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Affiliation(s)
- Amandine Crombé
- Department of Musculoskeletal Imaging, Pellegrin University Hospital, Bordeaux University, Place Amélie Raba-Léon, F-33000 Bordeaux, France
| | - David Fadli
- Department of Musculoskeletal Imaging, Pellegrin University Hospital, Bordeaux University, Place Amélie Raba-Léon, F-33000 Bordeaux, France
| | - Roberta Clinca
- Department of Radiology, IRCCS Policlinico di Sant’Orsola, 40138 Bologna, Italy
| | - Giorgio Reverchon
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Luca Cevolani
- Orthopedic Oncology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Marco Girolami
- Department of Spine Surgery Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Olivier Hauger
- Department of Musculoskeletal Imaging, Pellegrin University Hospital, Bordeaux University, Place Amélie Raba-Léon, F-33000 Bordeaux, France
| | - George R. Matcuk
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Paolo Spinnato
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
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3
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Debs P, Boutin RD, Smith SE, Babic M, Blankenbaker D, Chandra V, Murphey M, Thottacherry E, Kreulen C, Fayad LM. Chronic Nonspinal Osteomyelitis in Adults: Consensus Recommendations on Percutaneous Bone Biopsies from the Society of Academic Bone Radiologists. Radiology 2024; 311:e231348. [PMID: 38625010 PMCID: PMC11070610 DOI: 10.1148/radiol.231348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
The diagnosis and management of chronic nonspinal osteomyelitis can be challenging, and guidelines regarding the appropriateness of performing percutaneous image-guided biopsies to acquire bone samples for microbiological analysis remain limited. An expert panel convened by the Society of Academic Bone Radiologists developed and endorsed consensus statements on the various indications for percutaneous image-guided biopsies to standardize care and eliminate inconsistencies across institutions. The issued statements pertain to several commonly encountered clinical presentations of chronic osteomyelitis and were supported by a literature review. For most patients, MRI can help guide management and effectively rule out osteomyelitis when performed soon after presentation. Additionally, in the appropriate clinical setting, open wounds such as sinus tracts and ulcers, as well as joint fluid aspirates, can be used for microbiological culture to determine the causative microorganism. If MRI findings are positive, surgery is not needed, and alternative sites for microbiological culture are not available, then percutaneous image-guided biopsies can be performed. The expert panel recommends that antibiotics be avoided or discontinued for an optimal period of 2 weeks prior to a biopsy whenever possible. Patients with extensive necrotic decubitus ulcers or other surgical emergencies should not undergo percutaneous image-guided biopsies but rather should be admitted for surgical debridement and intraoperative cultures. Multidisciplinary discussion and approach are crucial to ensure optimal diagnosis and care of patients diagnosed with chronic osteomyelitis.
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Affiliation(s)
- Patrick Debs
- From The Russell H. Morgan Department of Radiology and Radiological Science (P.D., L.M.F.), and Departments of Orthopaedic Surgery (L.M.F.) and Oncology (L.M.F.), The Johns Hopkins University Medical Institutions, 600 N Wolfe St, JHOC 3014, Baltimore, MD 21287; Department of Radiology (R.D.B.) and Division of Vascular Surgery, Department of Surgery (V.C.), Stanford University School of Medicine, Palo Alto, Calif; Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.E.S.); Infectious Disease Department, Cleveland Clinic, Cleveland, Ohio (M.B.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (D.B.); Musculoskeletal Imaging and Neuroradiology, ACR Institute for Radiologic Pathology, Silver Spring, Md (M.M.); Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, Calif (E.T.); and Department of Orthopaedic Surgery, University of California-Davis, Sacramento, Calif (C.K.)
| | - Robert D Boutin
- From The Russell H. Morgan Department of Radiology and Radiological Science (P.D., L.M.F.), and Departments of Orthopaedic Surgery (L.M.F.) and Oncology (L.M.F.), The Johns Hopkins University Medical Institutions, 600 N Wolfe St, JHOC 3014, Baltimore, MD 21287; Department of Radiology (R.D.B.) and Division of Vascular Surgery, Department of Surgery (V.C.), Stanford University School of Medicine, Palo Alto, Calif; Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.E.S.); Infectious Disease Department, Cleveland Clinic, Cleveland, Ohio (M.B.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (D.B.); Musculoskeletal Imaging and Neuroradiology, ACR Institute for Radiologic Pathology, Silver Spring, Md (M.M.); Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, Calif (E.T.); and Department of Orthopaedic Surgery, University of California-Davis, Sacramento, Calif (C.K.)
| | - Stacy E Smith
- From The Russell H. Morgan Department of Radiology and Radiological Science (P.D., L.M.F.), and Departments of Orthopaedic Surgery (L.M.F.) and Oncology (L.M.F.), The Johns Hopkins University Medical Institutions, 600 N Wolfe St, JHOC 3014, Baltimore, MD 21287; Department of Radiology (R.D.B.) and Division of Vascular Surgery, Department of Surgery (V.C.), Stanford University School of Medicine, Palo Alto, Calif; Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.E.S.); Infectious Disease Department, Cleveland Clinic, Cleveland, Ohio (M.B.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (D.B.); Musculoskeletal Imaging and Neuroradiology, ACR Institute for Radiologic Pathology, Silver Spring, Md (M.M.); Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, Calif (E.T.); and Department of Orthopaedic Surgery, University of California-Davis, Sacramento, Calif (C.K.)
| | - Maja Babic
- From The Russell H. Morgan Department of Radiology and Radiological Science (P.D., L.M.F.), and Departments of Orthopaedic Surgery (L.M.F.) and Oncology (L.M.F.), The Johns Hopkins University Medical Institutions, 600 N Wolfe St, JHOC 3014, Baltimore, MD 21287; Department of Radiology (R.D.B.) and Division of Vascular Surgery, Department of Surgery (V.C.), Stanford University School of Medicine, Palo Alto, Calif; Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.E.S.); Infectious Disease Department, Cleveland Clinic, Cleveland, Ohio (M.B.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (D.B.); Musculoskeletal Imaging and Neuroradiology, ACR Institute for Radiologic Pathology, Silver Spring, Md (M.M.); Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, Calif (E.T.); and Department of Orthopaedic Surgery, University of California-Davis, Sacramento, Calif (C.K.)
| | - Donna Blankenbaker
- From The Russell H. Morgan Department of Radiology and Radiological Science (P.D., L.M.F.), and Departments of Orthopaedic Surgery (L.M.F.) and Oncology (L.M.F.), The Johns Hopkins University Medical Institutions, 600 N Wolfe St, JHOC 3014, Baltimore, MD 21287; Department of Radiology (R.D.B.) and Division of Vascular Surgery, Department of Surgery (V.C.), Stanford University School of Medicine, Palo Alto, Calif; Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.E.S.); Infectious Disease Department, Cleveland Clinic, Cleveland, Ohio (M.B.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (D.B.); Musculoskeletal Imaging and Neuroradiology, ACR Institute for Radiologic Pathology, Silver Spring, Md (M.M.); Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, Calif (E.T.); and Department of Orthopaedic Surgery, University of California-Davis, Sacramento, Calif (C.K.)
| | - Venita Chandra
- From The Russell H. Morgan Department of Radiology and Radiological Science (P.D., L.M.F.), and Departments of Orthopaedic Surgery (L.M.F.) and Oncology (L.M.F.), The Johns Hopkins University Medical Institutions, 600 N Wolfe St, JHOC 3014, Baltimore, MD 21287; Department of Radiology (R.D.B.) and Division of Vascular Surgery, Department of Surgery (V.C.), Stanford University School of Medicine, Palo Alto, Calif; Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.E.S.); Infectious Disease Department, Cleveland Clinic, Cleveland, Ohio (M.B.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (D.B.); Musculoskeletal Imaging and Neuroradiology, ACR Institute for Radiologic Pathology, Silver Spring, Md (M.M.); Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, Calif (E.T.); and Department of Orthopaedic Surgery, University of California-Davis, Sacramento, Calif (C.K.)
| | - Mark Murphey
- From The Russell H. Morgan Department of Radiology and Radiological Science (P.D., L.M.F.), and Departments of Orthopaedic Surgery (L.M.F.) and Oncology (L.M.F.), The Johns Hopkins University Medical Institutions, 600 N Wolfe St, JHOC 3014, Baltimore, MD 21287; Department of Radiology (R.D.B.) and Division of Vascular Surgery, Department of Surgery (V.C.), Stanford University School of Medicine, Palo Alto, Calif; Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.E.S.); Infectious Disease Department, Cleveland Clinic, Cleveland, Ohio (M.B.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (D.B.); Musculoskeletal Imaging and Neuroradiology, ACR Institute for Radiologic Pathology, Silver Spring, Md (M.M.); Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, Calif (E.T.); and Department of Orthopaedic Surgery, University of California-Davis, Sacramento, Calif (C.K.)
| | - Elizabeth Thottacherry
- From The Russell H. Morgan Department of Radiology and Radiological Science (P.D., L.M.F.), and Departments of Orthopaedic Surgery (L.M.F.) and Oncology (L.M.F.), The Johns Hopkins University Medical Institutions, 600 N Wolfe St, JHOC 3014, Baltimore, MD 21287; Department of Radiology (R.D.B.) and Division of Vascular Surgery, Department of Surgery (V.C.), Stanford University School of Medicine, Palo Alto, Calif; Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.E.S.); Infectious Disease Department, Cleveland Clinic, Cleveland, Ohio (M.B.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (D.B.); Musculoskeletal Imaging and Neuroradiology, ACR Institute for Radiologic Pathology, Silver Spring, Md (M.M.); Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, Calif (E.T.); and Department of Orthopaedic Surgery, University of California-Davis, Sacramento, Calif (C.K.)
| | - Christopher Kreulen
- From The Russell H. Morgan Department of Radiology and Radiological Science (P.D., L.M.F.), and Departments of Orthopaedic Surgery (L.M.F.) and Oncology (L.M.F.), The Johns Hopkins University Medical Institutions, 600 N Wolfe St, JHOC 3014, Baltimore, MD 21287; Department of Radiology (R.D.B.) and Division of Vascular Surgery, Department of Surgery (V.C.), Stanford University School of Medicine, Palo Alto, Calif; Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.E.S.); Infectious Disease Department, Cleveland Clinic, Cleveland, Ohio (M.B.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (D.B.); Musculoskeletal Imaging and Neuroradiology, ACR Institute for Radiologic Pathology, Silver Spring, Md (M.M.); Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, Calif (E.T.); and Department of Orthopaedic Surgery, University of California-Davis, Sacramento, Calif (C.K.)
| | - Laura M Fayad
- From The Russell H. Morgan Department of Radiology and Radiological Science (P.D., L.M.F.), and Departments of Orthopaedic Surgery (L.M.F.) and Oncology (L.M.F.), The Johns Hopkins University Medical Institutions, 600 N Wolfe St, JHOC 3014, Baltimore, MD 21287; Department of Radiology (R.D.B.) and Division of Vascular Surgery, Department of Surgery (V.C.), Stanford University School of Medicine, Palo Alto, Calif; Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.E.S.); Infectious Disease Department, Cleveland Clinic, Cleveland, Ohio (M.B.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (D.B.); Musculoskeletal Imaging and Neuroradiology, ACR Institute for Radiologic Pathology, Silver Spring, Md (M.M.); Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, Calif (E.T.); and Department of Orthopaedic Surgery, University of California-Davis, Sacramento, Calif (C.K.)
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4
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Husseini JS, Hanly A, Omeroglu E, Nelson SB, Jesse MK, Simeone FJ, Chang CY. Can gas and infection coexist in the intervertebral disc? A retrospective analysis of percutaneously biopsied suspected discitis-osteomyelitis cases. Skeletal Radiol 2024:10.1007/s00256-024-04631-5. [PMID: 38413401 DOI: 10.1007/s00256-024-04631-5] [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: 01/02/2024] [Revised: 02/20/2024] [Accepted: 02/21/2024] [Indexed: 02/29/2024]
Abstract
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.
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Affiliation(s)
- Jad S Husseini
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Arnau Hanly
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Emre Omeroglu
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Sandra B Nelson
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Mary Kate Jesse
- Department of Radiology, University of Colorado, Aurora, CO, USA
| | - F Joseph Simeone
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, 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, 55 Fruit Street, Boston, MA, 02114, USA.
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5
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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 2024:10.1007/s00256-023-04558-3. [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] [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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