EARLY IMAGING AND COURSE-OF-DISEASE CONTROL MARKERS OF PYOGENIC VERTEBRAL OSTEOMYELITIS

Background. The diagnosis of early pyogenic vertebral osteomyelitis is essential for prompt determination of treatment strategy and prevention of suppurative-destructive complications, although the nonspecifi c clinical manifestation obstructs timely disease detection. Aim. To analyse the clinical accuracy of various radiological imaging methods for early detection and control over vertebral osteomyelitis course Materials and methods. A retrospective study of standardized clinical data of patients (N = 54) who underwent treatment at the Neurosurgery Department of the MМCC WR between 2010 and 2020 was carried out. Patients were observed for 12–36 months. Study fi ndings and discussion. Our study revealed that during radiological imaging, infl ammatory changes in the vertebrae specifi c to osteomyelitis were not found in any case, which signifi cantly delays the diagnosis. The study analysed and grouped radiological signs of the infl ammatory process spread in the vertebrae in case of spondylodiscitis by CT and MR stages. Spondylodiscitis was diagnosed by CT of the spine in the late third stage only in 29.0 % of patients. Nonspecifi c destructive changes of vertebrae were detected in 51.6% of persons, which required additional MRI examination to establish the diagnosis. In 19.4% of those examined in the presence of the fi rst MR stage, no specifi c CT signs of osteomyelitis were found. MRI scan of the spine is the main specifi c (93 %), accurate (94 %) and sensitive (97 %) method for early detection of pyogenic osteomyelitis. Although according to the world literature, MRI is not sensitive enough to assess the dynamics of the infl ammatory process in the spine, the progressive increase in signal intensity of vertebral cortex on T1-weighted images within aff ected vertebrae correlates well with infl ammation resolving and C-reactive protein (CRP) level normalization. We described this radiological sign as a «vertebral rim» phenomenon (VRP). In our study, a reliable correlation was found between CRP level and the «vertebral rim» phenomenon on MRI. Conclusions. For early detection of pyogenic vertebral osteomyelitis, MRI examination is the main specifi c and sensitive method. We suggest combining the CRP level and «vertebral rim» sign in practice as dynamics of spondylodiscitis markers and justifi cation of antibacterial therapy strategy.

Download Full-text

Validity of Clinical Assessment Using Clinical Symptoms and C-Reactive Protein for Therapeutic Response in Pyogenic Vertebral Osteomyelitis: Analysis Based on 18F-FDG-PET

Medicina ◽

10.3390/medicina57080809 ◽

2021 ◽

Vol 57 (8) ◽

pp. 809

Author(s):

Ikchan Jeon ◽

Dongwoo Yu ◽

Eunjung Kong

Keyword(s):

Antibiotic Therapy ◽

Clinical Assessment ◽

Fdg Pet ◽

Therapeutic Response ◽

Clinical Symptoms ◽

Vertebral Osteomyelitis ◽

Parenteral Antibiotic ◽

Reactive Protein ◽

Pyogenic Vertebral Osteomyelitis ◽

18F Fdg

Backgroundand objectives: The clinical assessment of therapeutic response in pyogenic vertebral osteomyelitis (PVO) has been usually performed based on the changes of clinical symptoms and blood inflammatory markers. Recently, 18F-fluorodeoxyglucose positron emission tomography (18F-FDG-PET) has emerged as an alternative independent method. We analyzed the validity of the clinical assessment for detecting residual PVO based on 18F-FDG-PET. Materials and Methods: This study was conducted with 53 patients confirmed as lumbar PVO under retrospective design. All patients underwent clinical assessment using clinical symptoms and C-reactive protein (CRP) for therapeutic response after parenteral antibiotic therapy, which led to the decision of placement in the uncontrolled (group UC) or controlled (group C) group. The validity of clinical assessment was analyzed based on the cut-off values of FDG uptake for detecting residual PVO as references, which are already established in the previous literature. Results: The mean duration of parenteral antibiotic therapy and recurrence rate were 42.19 ± 15.84 (21–89) days and 9.4% (5/53), respectively. 18F-FDG-PETs were performed at 80 rounds of clinical assessment on 37.40 ± 13.15 (21–83) days of parenteral antibiotic therapy and divided: 31 into group UC and 49 into group C, according to the decisions of clinical assessment. Based on the cut-off values of FDG uptake, clinical assessment showed 48.4–58.1% of false positive for residual PVO in group UC. However, 18F-FDG-PET showed 8.2% (4/49) of false negative for residual PVO in group C, which led to recurrences. Conclusions: Clinical assessment using clinical symptoms and CRP for evaluating therapeutic response in PVO is still a useful method in terms of similar recurrence rate compared to 18F-FDG-PET. However, the high rate of false positive for residual PVO can prolong the use of unnecessary antibiotics and overall treatment period.

Download Full-text

Factors Influencing Culture Positivity in Pyogenic Vertebral Osteomyelitis Patients with Prior Antibiotic Exposure

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.04949-14 ◽

2015 ◽

Vol 59 (4) ◽

pp. 2470-2473 ◽

Cited By ~ 16

Author(s):

Chung-Jong Kim ◽

Seung-Ji Kang ◽

Doran Yoon ◽

Myung Jin Lee ◽

Moonsuk Kim ◽

...

Keyword(s):

Tissue Culture ◽

Confidence Interval ◽

Vertebral Osteomyelitis ◽

C Reactive Protein ◽

Surgical Biopsy ◽

Reactive Protein ◽

Factors Influencing ◽

Culture Positivity ◽

Open Surgical Biopsy ◽

Pyogenic Vertebral Osteomyelitis

ABSTRACTWe conducted a retrospective cohort study to evaluate factors influencing tissue culture positivity in patients with pyogenic vertebral osteomyelitis exposed to antibiotics before diagnosis. Tissue culture was positive in 48.3% (28/58) of the patients, and the median antibiotic-free period was 1.5 days (range, 0.7 to 5.7 days). In a multivariate analysis, a higher C-reactive protein (CRP) level (adjusted odds ratio [aOR], 1.18; 95% confidence interval, 1.07 to 1.29) and open surgical biopsy (aOR, 6.33; 95% confidence interval, 1.12 to 35.86) were associated with tissue culture positivity.

Download Full-text

Interest of Follow-Up Radiological Imaging in Patients with Pyogenic Vertebral Osteomyelitis

Journal of Clinical Medicine ◽

10.3390/jcm10122690 ◽

2021 ◽

Vol 10 (12) ◽

pp. 2690

Author(s):

Sophie Hecquet ◽

Frank Verhoeven ◽

Sébastien Aubry ◽

Clément Prati ◽

Daniel Wendling ◽

...

Keyword(s):

Cohort Analysis ◽

Vertebral Osteomyelitis ◽

Radiological Imaging ◽

Mean Delay ◽

Retrospective Cohort Analysis ◽

New Locations ◽

Pyogenic Vertebral Osteomyelitis ◽

The Mean ◽

Magnetic Resonance Imaging Mri

No recommendations are established for monitoring pyogenic vertebral osteomyelitis (PVO). Thus, the realization of systematic follow-up radiological imaging is controversial. The objective of this study was to evaluate the interest in follow-up radiological imaging in patients with PVO. We conducted a retrospective cohort analysis of patients with PVO who had both baseline and follow-up radiological imaging. We classified the follow-up images into two groups, improvement/stability, and deterioration, compared with the baseline data. For each patient, we compared their radiological imaging follow-up to their clinical-biological condition assessed at the same time. Eighty-six patients were included. The mean age was 68 years (±13). A total of 99 radiological imaging examinations at diagnosis and at follow-up were analyzed, 69 Magnetic Resonance Imaging (MRI), and 30 Computerized Tomography (CT scans). The mean delay between the follow-up radiological imaging and clinical evaluation was 2.8 +/− 2.1 months. Of the 36 patients with clinical and biological recovery, 24 patients (67%) had improved radiological imaging and 12 patients (34%) had radiological worsening (new abscesses (n = 4), extension of soft tissue infiltration (n = 2) and/or epiduritis (n = 2) or appearance of new locations (n = 1)). Among the 50 patients considered as unhealed, on the contrary, radiological imaging showed an improvement in imaging in 39 patients (78%) and a worsening in 11 patients (22%). Our study showed that there was no correlation between the clinical condition of patients and their follow-up radiological imaging in the context of PVO.

Download Full-text

Prediction of Recurrence in Pyogenic Vertebral Osteomyelitis by Artificial Neural Network Using Time-Series Data of C-Reactive Protein

Spine ◽

10.1097/brs.0000000000003985 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Jihye Kim ◽

Hwan Ryu ◽

Seok Woo Kim ◽

Jae-Keun Oh ◽

Tae-Hwan Kim

Keyword(s):

Neural Network ◽

Time Series ◽

Artificial Neural Network ◽

Time Series Data ◽

Vertebral Osteomyelitis ◽

Series Data ◽

C Reactive Protein ◽

Reactive Protein ◽

Pyogenic Vertebral Osteomyelitis ◽

Artificial Neural

Download Full-text

Assessment of Therapeutic Response in Pyogenic Vertebral Osteomyelitis Using 18F-FDG-PET/MRI

Diagnostics ◽

10.3390/diagnostics10110916 ◽

2020 ◽

Vol 10 (11) ◽

pp. 916

Author(s):

Ikchan Jeon ◽

Eunjung Kong ◽

Sang Woo Kim ◽

Ihn Ho Cho ◽

Cheol Pyo Hong

Keyword(s):

Fdg Pet ◽

Therapeutic Response ◽

Vertebral Osteomyelitis ◽

Standardized Uptake Value ◽

Clinical Assessments ◽

Fdg Uptake ◽

Reactive Protein ◽

Positron Emission ◽

Pyogenic Vertebral Osteomyelitis ◽

Magnetic Resonance Imaging Mri

Purpose: There is still no definite method to determine therapeutic response in pyogenic vertebral osteomyelitis (PVO). We analyzed the value of 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) for assessing therapeutic response in PVO. Methods: This retrospective study included 53 patients (32 men and 21 women) with lumbar PVO. The results of clinical assessments for therapeutic response were divided into “Cured” (group C) and “Non-cured” (group NC). The differences in clinical and radiological features of PVO lesions between the two groups were analyzed using clinical data and simultaneous FDG-PET/magnetic resonance imaging (MRI) obtained at each clinical assessment. Results: Clinical assessments and FDG-PET/MRIs were performed at 41.89 ± 16.08 (21–91) days of parenteral antibiotic therapy. There were 39 patients in group C and 14 in group NC. Diagnostic accuracies (DAs) of FDG uptake intensity-based interpretation and C-reactive protein (CRP) for residual PVO were as follows (p < 0.01): 84.9% of the maximum standardized uptake value of PVO lesion (PvoSUVmax), 86.8% of ΔPvoSUVmax−NmlSUVmax (SUVmax of normal vertebra), 86.8% of ΔPvoSUVmax−NmlSUVmean (SUVmean of normal vertebra), and 71.7% of CRP. DAs were better (92.5–94.3%) when applying FDG uptake intensity-based interpretation and CRP together. Under the FDG uptake distribution-based interpretation, FDG uptake was significantly limited to intervertebral structures in group C (p = 0.026). Conclusion: The interpretations of intensity and distribution of FDG uptake on FDG-PET are useful for detecting residual PVO in the assessment of therapeutic response of PVO. The combination of FDG-PET and CRP is expected to increase DA for detecting residual PVO.

Download Full-text