title: Association Between Follow-Up Magnetic Resonance Imaging and Clinical Status Among Patients With Spinal Infections.
abstract: 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.
authors.affiliation: Department of Internal Medicine, University of California San Francisco, San Francisco, CA.
authors.forename: Sanjiv
authors.initials: S
authors.lastname: Baxi
authors.affiliation: Division of Geriatric Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI ; Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI ; Geriatric Research, Education, and Clinical Center (GRECC), Ann Arbor, MI ; Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI.
authors.forename: Preeti N
authors.initials: PN
authors.lastname: Malani
authors.affiliation: Division of Neuroradiology, Department of Radiology, University of Michigan Health System, Ann Arbor, MI.
authors.forename: Diana
authors.initials: D
authors.lastname: Gomez-Hassan
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI ; Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI.
authors.forename: Sandro K
authors.initials: SK
authors.lastname: Cinti
keywords: discitis; magnetic resonance imaging; spinal infections; vertebral osteomyelitis
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