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Published on: May 7, 2019
Association Between Follow-Up Magnetic Resonance Imaging and Clinical Status Among Patients With Spinal Infections
Sanjiv Baxi1, Preeti N Malani2, Diana Gomez-Hassan3
1Department of Internal Medicine, University of California San Francisco, San Francisco, CA.
Background:
Spinal infections, including paraspinal and/or epidural abscesses and vertebral discitis and osteomyelitis, can have devastating consequences. The diagnostic imaging modality of choice has traditionally been magnetic resonance imaging (MRI) given the very high sensitivity and specificity, although the role of MRI in follow-up of spinal infections and how this relates to follow-up clinical status is poorly understood. We sought to understand the relationship between follow-up MRI and clinical status.
Methods:
We conducted a retrospective review of adults with spinal infection to assess the relationship between follow-up MRI and clinical course. The degree of agreement between MRI and clinical follow-up was assessed using the Cohen kappa coefficient. A multinomial logistic regression model was applied to assess the impact of covariates in affecting the clinical outcome and MRI at follow-up independently.
Results:
Ninety-eight patients met inclusion criteria during a 13-year period. We observed a lack of correlation between clinical follow-up status and MRI (κ = 0.065, P = 0.322). The McNemar-Bowker test for symmetry revealed that this disagreement was asymmetric (P < 0.001). Notably, clinical worsening was never associated with an improved MRI, and clinical improvement was overall not predictive of MRI result and vice versa.
Conclusions:
Routine follow-up MRI does not seem to correlate with clinical follow-up among patients with spinal infections. The use of MRI without new clinical indications in routine follow-up testing should be interpreted with caution.
Insights
Follow-up magnetic resonance imaging (MRI) in spinal infections shows poor correlation with patient clinical status. Routine MRI use without new symptoms may lead to misinterpretation of treatment effectiveness.
Area of Science:
- Infectious Diseases
- Radiology
- Orthopedic Surgery
Background:
- Spinal infections, such as epidural abscesses and vertebral osteomyelitis, pose significant health risks.
- Magnetic resonance imaging (MRI) is the standard diagnostic tool, but its utility in monitoring treatment response is unclear.
Purpose of the Study:
- To investigate the relationship between follow-up MRI findings and clinical status in patients with spinal infections.
Main Methods:
- A retrospective review of 98 adult patients with spinal infections over 13 years.
- Assessed agreement between MRI and clinical follow-up using Cohen kappa coefficient.
- Used multinomial logistic regression to analyze clinical outcome and MRI impact.
Main Results:
- A significant lack of correlation was observed between clinical follow-up status and MRI findings (κ = 0.065, P = 0.322).
- The disagreement between clinical and imaging data was asymmetric (P < 0.001).
- Clinical worsening did not correlate with MRI improvement, and clinical improvement did not predict MRI results.
Conclusions:
- Routine follow-up MRI in spinal infection patients does not consistently correlate with clinical outcomes.
- Interpreting follow-up MRI results cautiously is advised, especially in the absence of new clinical indications.
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