Diagnostic Yield of Multidetector Computed Tomography in Patients with Acute Spondylodiscitis

Purpose To determine the value of multidetector computed tomography (MDCT) in patients with acute spondylodiscitis. Methods and Materials For data acquisition, we searched our radiological database for all patients who had undergone magnetic resonance imaging (MRI) for suspected spondylodiscitis between 2007 and 2015 (n = 325). For further analyses, we included all patients (n = 67) who initially underwent MDCT prior to MRI. Overall accuracy, sensitivity, specificity and positive and negative predictive values were calculated for MDCT and, separately, for contrast-enhanced CT (CECT, n = 36) and for non-enhanced CT (NECT, n = 31). MRI together with clinical evaluation served as the standard of reference.

In 34 of 43 patients with acute spondylodiscitis on MRI, correct diagnosis was already made by the initial MDCT scan. The specificity and positive predictive value were 100 % for MDCT. The sensitivity was 79 % and the negative predictive value was 72 %. The overall accuracy was 87 %. Accuracy was higher for CECT (89 %) than for NECT (84 %), however without statistical significance (p = 0.55). MDCT detected 90 % of paravertebral abscesses (34/38), but only 6 % of epidural abscesses (2/36). Conclusion MDCT has moderate sensitivity, but high specificity for acute spondylodiscitis. Thus, if MDCT is positive for spondylodiscitis, treatment can be started without further delay. However, MRI should be added to both MDCT negative and positive cases to rule out complications such as epidural abscesses that cannot reliably be detected by MDCT. Key Points:  · Patients with acute spondylodiscitis are often initially suspected of having other differential diagnosis because of nonspecific symptoms.. · Therefore, MDCT is frequently performed prior to MRI in patients with acute spondylodiscitis.. · MDCT proved moderate sensitivity but high specificity for the diagnosis of acute spondylodiscitis.. · Paravertebral abscess is a strong indicator for the presence of spondylodiscitis on MDCT.. · However, MRI is crucial to rule out epidural abscesses, an important complication.. Citation Format · Rausch VH, Bannas P, Schoen G et al. Diagnostic Yield of Multidetector Computed Tomography in Patients with Acute Spondylodiscitis. Fortschr Röntgenstr 2017; 189: 339 - 346.