title: CT-Guided Biopsy in Suspected Spondylodiscitis--The Association of Paravertebral Inflammation with Microbial Pathogen Detection.
abstract: OBJECTIVE
  To search for imaging characteristics distinguishing patients with successful from those with futile microbiological pathogen detection by CT-guided biopsy in suspected spondylodiscitis.
  
  
  METHODS
  34 consecutive patients with suspected spondylodiscitis underwent CT-guided biopsy for pathogen detection. MR-images were assessed for inflammatory infiltration of disks, adjacent vertebrae, epidural and paravertebral space. CT-images were reviewed for arrosion of adjacent end plates and reduced disk height. Biopsy samples were sent for microbiological examination in 34/34 patients, and for additional histological analysis in 28/34 patients.
  
  
  RESULTS
  Paravertebral infiltration was present in all 10/10 patients with positive microbiology and occurred in only 12/24 patients with negative microbiology, resulting in a sensitivity of 100% and a specificity of 50% for pathogen detection. Despite its limited sensitivities, epidural infiltration and paravertebral abscesses showed considerably higher specificities of 83.3% and 90.9%, respectively. Paravertebral infiltration was more extensive in patients with positive as compared to negative microbiology (p = 0.002). Even though sensitivities for pathogen detection were also high in case of vertebral and disk infiltration, or end plate arrosion, specificities remained below 10%.
  
  
  CONCLUSIONS
  Inflammatory infiltration of the paravertebral space indicated successful pathogen detection by CT-guided biopsy. Specificity was increased by the additional occurrence of epidural infiltration or paravertebral abscesses.
authors.affiliation: Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Spira
authors.affiliation: Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Germann
authors.affiliation: Clinic for Orthopedics and Trauma Surgery, University Hospital Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany.
authors.forename: Burkhard
authors.initials: B
authors.lastname: Lehner
authors.affiliation: Clinic for Orthopedics and Trauma Surgery, University Hospital Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Hemmer
authors.affiliation: Clinic for Orthopedics and Trauma Surgery, University Hospital Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Akbar
authors.affiliation: Department of Neuroradiology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
authors.forename: Jessica
authors.initials: J
authors.lastname: Jesser
authors.affiliation: Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.
authors.forename: Marc-André
authors.initials: MA
authors.lastname: Weber
authors.affiliation: Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Rehnitz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D064207:Aggregatibacter aphrophilus / Q000302:isolation & purification; D001170:Arthritis, Infectious / Q000382:microbiology / Q000473:pathology*; D002648:Child; D003287:Contrast Media; D015299:Discitis / Q000382:microbiology / Q000473:pathology*; D004198:Disease Susceptibility; D004755:Enterobacteriaceae / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000382:microbiology / Q000473:pathology; D004824:Epidural Space / Q000382:microbiology / Q000473:pathology; D005260:Female; D006801:Humans; D061705:Image-Guided Biopsy; D007403:Intervertebral Disc / Q000382:microbiology / Q000473:pathology*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008536:Meglumine; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification; D008875:Middle Aged; D064847:Multimodal Imaging; D009942:Organometallic Compounds; D016871:Pasteurellaceae Infections / Q000382:microbiology / Q000473:pathology; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013131:Spine / Q000382:microbiology / Q000473:pathology*; D013203:Staphylococcal Infections / Q000382:microbiology / Q000473:pathology; D013210:Staphylococcus / Q000302:isolation & purification; D014057:Tomography, X-Ray Computed; D014399:Tuberculosis, Spinal / Q000382:microbiology / Q000473:pathology; D055815:Young Adult
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; D008536:Meglumine; C072417:gadoterate meglumine