title: Diagnostic Yield of Multidetector Computed Tomography in Patients with Acute Spondylodiscitis.
abstract: PurposeTo determine the value of multidetector computed tomography (MDCT) in patients with acute spondylodiscitis.Methods and MaterialsFor data acquisition, we searched our radiological database for all patients who had undergone magnetic resonance imaging (MRI) for suspected spondylodiscitis between 2007 and 2015 (n = 325). For further analyses, we included all patients (n = 67) who initially underwent MDCT prior to MRI. Overall accuracy, sensitivity, specificity and positive and negative predictive values were calculated for MDCT and, separately, for contrast-enhanced CT (CECT, n = 36) and for non-enhanced CT (NECT, n = 31). MRI together with clinical evaluation served as the standard of reference.
  
  
  RESULTS
  In 34 of 43 patients with acute spondylodiscitis on MRI, correct diagnosis was already made by the initial MDCT scan. The specificity and positive predictive value were 100 % for MDCT. The sensitivity was 79 % and the negative predictive value was 72 %. The overall accuracy was 87 %. Accuracy was higher for CECT (89 %) than for NECT (84 %), however without statistical significance (p = 0.55). MDCT detected 90 % of paravertebral abscesses (34/38), but only 6 % of epidural abscesses (2/36).ConclusionMDCT has moderate sensitivity, but high specificity for acute spondylodiscitis. Thus, if MDCT is positive for spondylodiscitis, treatment can be started without further delay. However, MRI should be added to both MDCT negative and positive cases to rule out complications such as epidural abscesses that cannot reliably be detected by MDCT.Key Points:· Patients with acute spondylodiscitis are often initially suspected of having other differential diagnosis because of nonspecific symptoms.. · Therefore, MDCT is frequently performed prior to MRI in patients with acute spondylodiscitis.. · MDCT proved moderate sensitivity but high specificity for the diagnosis of acute spondylodiscitis.. · Paravertebral abscess is a strong indicator for the presence of spondylodiscitis on MDCT.. · However, MRI is crucial to rule out epidural abscesses, an important complication..Citation Format· Rausch VH, Bannas P, Schoen G et al. Diagnostic Yield of Multidetector Computed Tomography in Patients with Acute Spondylodiscitis. Fortschr Röntgenstr 2017; 189: 339 - 346.
authors.affiliation: Department of Diagnostic and Interventional Radiology and Nuclearmedicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Vanessa Hanna
authors.initials: VH
authors.lastname: Rausch
authors.affiliation: Department of Diagnostic and Interventional Radiology and Nuclearmedicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Bannas
authors.affiliation: Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schoen
authors.affiliation: Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Froelich
authors.affiliation: Department of Diagnostic and Interventional Radiology and Nuclearmedicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Lennart
authors.initials: L
authors.lastname: Well
authors.affiliation: Department of Diagnostic and Interventional Radiology and Nuclearmedicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Marc
authors.initials: M
authors.lastname: Regier
authors.affiliation: Department of Diagnostic and Interventional Radiology and Nuclearmedicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Adam
authors.affiliation: Department of Diagnostic and Interventional Radiology and Nuclearmedicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Frank Oliver Gerhard
authors.initials: FO
authors.lastname: Henes
mesh_terms: D000208:Acute Disease; D015299:Discitis / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D061330:Multidetector Computed Tomography / Q000379:methods*; D064847:Multimodal Imaging / Q000379:methods*; D015588:Observer Variation; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity