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Finding MRI features to obviate the need of repeat spinal biopsies in clinically suspected persistent or recurrent
Stephany Barreto1, Salil Sharma2, Gaurav Cheraya3
1SUNY Upstate University Hospital, Syracuse, NY 13210, USA.
Purpose:
The aim of this study was to determine magnetic resonance imaging (MRI) features that could help differen-tiate the bone destruction due to persistent/recurrent spine infection from worsening bone destruction due to mechanical factors, which could help obviate the need for repeat spine biopsy.
Material And Methods:
A retrospective study was performed on selected subjects who were more than 18 years of age, were diagnosed with infectious spondylodiscitis, underwent at least 2 spinal interventions for the diagnosis at the same level, and had MRI prior to each image-guided intervention. Both MRI studies were analysed for vertebral body changes, paravertebral collections, epidural thickening and collections, bone marrow signal changes, loss of vertebral body height, abnormal signal in intervertebral disc, and loss of disc height.
Results:
We observed that worsening of changes in paravertebral and epidural soft tissue were statistically more significant predictors of recurrent/persistent spine infection (p< 0.05). However, worsening destruction of vertebral body and intervertebral disc, abnormal vertebral marrow signal changes, and abnormal signal in intervertebral disc did not necessarily indicate worsening infection or recurrence.
Conclusions:
In patients of infectious spondylitis with suspected recurrence, the most common and pronounced MRI findings of worsening osseous changes can be deceiving and can result in negative repeat spinal biopsy. Changes in paraspinal and epidural soft tissues are more helpful in identifying the cause of worsening bone destruction. Correlation with clinical examination, inflammatory markers, and observing soft tissue changes on follow-up MRI is a more reliable way to identify patients who may benefit from repeat spine biopsy.
Insights
Magnetic resonance imaging (MRI) can help differentiate spine infection from mechanical bone destruction. Worsening soft tissue changes, not bone destruction, are key indicators of recurrent infection, potentially avoiding repeat biopsies.
Area of Science:
- Radiology
- Orthopedics
- Infectious Diseases
Background:
- Differentiating recurrent spine infection from mechanical factors in infectious spondylodiscitis is challenging.
- Repeat spine biopsy may be needed but can be invasive and yield negative results.
- Magnetic resonance imaging (MRI) is crucial for monitoring treatment response and disease progression.
Purpose of the Study:
- To identify specific MRI features that distinguish bone destruction from persistent/recurrent spine infection versus mechanical causes.
- To reduce the need for repeat spine biopsies by improving diagnostic accuracy.
Main Methods:
- Retrospective analysis of MRI studies in patients over 18 with infectious spondylodiscitis and at least two spinal interventions.
- Evaluation of MRI features including vertebral body changes, paravertebral/epidural collections, bone marrow signal, and disc abnormalities.
- Correlation of MRI findings with clinical outcomes.
Main Results:
- Worsening paravertebral and epidural soft tissue changes were significant predictors of recurrent/persistent spine infection (p<0.05).
- Worsening vertebral body/disc destruction and abnormal marrow/disc signals did not reliably indicate infection recurrence.
- MRI findings of osseous changes can be misleading in cases of suspected recurrence.
Conclusions:
- Soft tissue changes on MRI are more indicative of recurrent spine infection than osseous changes.
- Relying solely on worsening bone destruction on MRI can lead to unnecessary repeat biopsies.
- Integrating MRI soft tissue findings with clinical examination and inflammatory markers improves diagnostic accuracy for recurrent infectious spondylitis.
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