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Predictive Performance of MRI for Antibiotic Treatment Failure of Pyogenic Vertebral Osteomyelitis: A Validation
Sugihiro Hamaguchi1,2, Sei Takahashi1,3, Yuji Endo4
1Department of General Internal Medicine, Fukushima Medical University, Fukushima, JPN.
Introduction:
Intravenous antibiotics are the primary treatment of choice for pyogenic vertebral osteomyelitis (PVO). Surgical intervention is required when the initial antibiotic treatment fails but is often difficult to perform, especially in older adults with multiple comorbidities, because of the reduced physical activity. The size of the infection signal in the spinal bone on magnetic resonance imaging (MRI) at the time of diagnosis was reported to have a high predictive accuracy for antibiotic treatment failure. However, the sample size was too small for this result to be adopted in clinical practice. Thus, we conducted a validation study of the previous research using a larger sample size.
Methods:
We conducted a retrospective review of electronic medical records of patients admitted to the orthopedic department of a university hospital with a diagnosis of PVO between 2006 and 2021, and consecutively included patients without planned PVO surgery on admission and with a sagittal view of T1-weighted spinal MRI at the time of diagnosis. The index test was the percentage involvement of the affected areas in one motion segment on sagittal MRI. We also evaluated other MRI findings, such as bone destruction, segmental instability, epidural abscesses, and multiple sites for their predictive accuracy for antibiotic treatment failure.
Results:
A total of 82 participants were eligible for the analysis. The presence of ≥90% affected area of one motion segment had a sensitivity of 16.7% and a specificity of 70.3% for future antibiotic treatment failure, resulting in poor predictive performance, with positive (LR+) and negative likelihood ratios of 0.56 and 1.19, respectively. The area under the receiver operating characteristic curve for a 10% increase in the affected area was 0.48. Among the other MRI findings, the presence of bone destruction had a significantly higher predictive accuracy (LR+ 3.11, 95% confidence interval 1.30-7.42).
Conclusion:
An infection signal ≥90% on a T1-weighted MRI of one spinal motion segment did not show sufficient predictive performance for antibiotic treatment failure. Spinal bone destruction had a mild-to-moderate predictive accuracy.
Insights
A large MRI signal in the spine did not accurately predict antibiotic treatment failure in pyogenic vertebral osteomyelitis (PVO). Spinal bone destruction showed mild-to-moderate predictive accuracy for treatment outcomes.
Area of Science:
- Orthopedics
- Radiology
- Infectious Diseases
Background:
- Pyogenic vertebral osteomyelitis (PVO) is primarily treated with intravenous antibiotics.
- Surgical intervention is reserved for cases of antibiotic treatment failure but poses challenges, especially in elderly patients with comorbidities.
- Previous studies suggested MRI signal size predicts treatment failure, but required validation with larger sample sizes.
Purpose of the Study:
- To validate the predictive accuracy of MRI findings for antibiotic treatment failure in PVO.
- To assess the utility of infection signal size and other MRI features in predicting treatment outcomes.
Main Methods:
- Retrospective review of 82 patients diagnosed with PVO between 2006 and 2021.
- Analysis of T1-weighted sagittal spinal MRI at diagnosis, focusing on percentage of motion segment involvement.
- Evaluation of other MRI findings including bone destruction, instability, and epidural abscesses for predictive accuracy.
Main Results:
- A ≥90% infection signal in one motion segment showed poor predictive performance for antibiotic treatment failure (sensitivity 16.7%, specificity 70.3%).
- The area under the ROC curve for a 10% increase in affected area was 0.48.
- Spinal bone destruction emerged as a significant predictor, with higher predictive accuracy (LR+ 3.11).
Conclusions:
- A large infection signal (≥90%) on T1-weighted MRI is not a reliable predictor of antibiotic treatment failure in PVO.
- Spinal bone destruction on MRI offers mild-to-moderate predictive value for treatment outcomes in PVO.
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