title: Is Biopsying the Paravertebral Soft Tissue as Effective as Biopsying the Disk or Vertebral Endplate? 10-Year Retrospective Review of CT-Guided Biopsy of Diskitis-Osteomyelitis.
abstract: OBJECTIVE
  The purpose of this study was to determine whether there is a difference in biopsying bone (endplate), disk, or paravertebral soft tissue to culture the pathogenic organism causing diskitis-osteomyelitis.
  
  
  METHODS
  A retrospective review was conducted of 111 spinal biopsies performed between 2002 and 2011. Pathologic examination was used as the reference standard for detecting diskitis-osteomyelitis. Microbiologic yield, sensitivity, and specificity were calculated. The yields for different groups were compared by use of Fisher exact test. The analysis was repeated with biopsy samples from patients not being treated with antibiotics at the time of biopsy.
  
  
  RESULTS
  A total of 122 biopsy specimens were obtained from 111 spinal biopsy procedures on 102 patients. Overall, 27 (22%) biopsies were performed on the endplate-disk, 61 (50%) on the disk only, and 34 (28%) on paravertebral soft tissue only. The microbiologic yield was 36% for all biopsies, 19% for endplate-disk biopsies, 39% for disk-only biopsies, and 44% for soft-tissue biopsies. The sensitivity and specificity of the microbiologic results for all specimens were 57% and 89%; endplate-disk, 38% and 86%; disk only, 57% and 89%; and paravertebral soft tissue, 68% and 92%. There was no statistically significant difference between the yields of the endplate-disk, disk-only, and paravertebral soft-tissue biopsies.
  
  
  CONCLUSIONS
  Paravertebral soft-tissue changes, when present, may be considered a viable target for biopsy in cases of diskitis-osteomyelitis, even in the absence of a paravertebral abscess.
authors.affiliation: 1 Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital, 55 Fruit St, Yawkey 6E, Boston, MA 02114.
authors.forename: Connie Y
authors.initials: CY
authors.lastname: Chang
authors.affiliation: 1 Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital, 55 Fruit St, Yawkey 6E, Boston, MA 02114.
authors.forename: F Joseph
authors.initials: FJ
authors.lastname: Simeone
authors.affiliation: 2 Department of Medicine, Infectious Disease Unit, Massachusetts General Hospital, Boston, MA.
authors.forename: Sandra B
authors.initials: SB
authors.lastname: Nelson
authors.affiliation: 3 Imaging Department, Musculoskeletal Radiology Division, Diagnostic Center, Hospital Israelita Albert Einstein, Hospital do Coração and Teleimagem, São Paulo, Brazil.
authors.forename: Atul K
authors.initials: AK
authors.lastname: Taneja
authors.affiliation: 1 Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital, 55 Fruit St, Yawkey 6E, Boston, MA 02114.
authors.forename: Ambrose J
authors.initials: AJ
authors.lastname: Huang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015299:Discitis / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D006801:Humans; D061705:Image-Guided Biopsy; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000000981:diagnostic imaging / Q000473:pathology*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013122:Spinal Diseases / Q000000981:diagnostic imaging / Q000473:pathology*; D014057:Tomography, X-Ray Computed
keywords: CT-guided biopsy; culture; diskitis-osteomyelitis; spine