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<meta name="DC.Title" content="Combination of Imaging Features and Clinical Biomarkers Predicts Positive Pathology and Microbiology Findings Suggestive of Spondylodiscitis in Patients Undergoing Image-Guided Percutaneous Biopsy" />
<meta name="DC.Identifier" content="10.3174/ajnr.A6623" />
<meta name="DC.Date" content="2020-07-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
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<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Pathology and microbiology results for suspected spondylodiscitis on MR imaging are often negative in up to 70% of cases. We aimed to predict whether MR imaging features will add diagnostic value when combined with clinical biomarkers to predict positive findings of spondylodiscitis on pathology and/or microbiology from percutaneous biopsy.

MATERIALS AND METHODS: In this retrospective single-center institutional review board–approved study, patients with radiologically suspected spondylodiscitis and having undergone percutaneous biopsies were assessed. Demographic characteristics, laboratory values, and tissue and blood cultures were collected. Pathology and microbiology results were used as end points. Three independent observers provided MR imaging–based scoring for typical MR imaging features for spondylodiscitis. Multivariate logistic regression and receiver operating characteristic analysis were performed to determine an optimal combination of imaging and clinical biomarkers in predicting positive findings on pathology and/or microbiology from percutaneous biopsy suggestive of spondylodiscitis.

RESULTS: Our patient cohort consisted of 72 patients, of whom 33.3% (24/72) had spondylodiscitis. The mean age was 63 ± 16 years with a male/female ratio of 41:31. Logistic regression revealed a combination with an area under the curve of 0.72 for pathology and 0.68 for pathology and/or microbiology. Epidural enhancement on MR imaging improved predictive performance to 0.87 for pathology and 0.78 for pathology and/or microbiology.

CONCLUSIONS: Our findings demonstrate that epidural enhancement on MR imaging added diagnostic value when combined with clinical biomarkers to help predict which patients undergoing percutaneous biopsy will have positive findings for spondylodiscitis on pathology and/or microbiology.

AUC
:   area under the curve
CRP
:   C-reactive protein
ESR
:   erythrocyte sedimentation rate
NPV
:   negative predictive value
PPV
:   positive predictive value" />
<meta name="DC.Contributor" content="S. Kihira" />
<meta name="DC.Contributor" content="C. Koo" />
<meta name="DC.Contributor" content="K. Mahmoudi" />
<meta name="DC.Contributor" content="T. Leong" />
<meta name="DC.Contributor" content="X. Mei" />
<meta name="DC.Contributor" content="B. Rigney" />
<meta name="DC.Contributor" content="A. Aggarwal" />
<meta name="DC.Contributor" content="A.H. Doshi" />
<meta name="article:published_time" content="2020-07-01" />
<meta name="article:section" content="Spine" />
<meta name="citation_title" content="Combination of Imaging Features and Clinical Biomarkers Predicts Positive Pathology and Microbiology Findings Suggestive of Spondylodiscitis in Patients Undergoing Image-Guided Percutaneous Biopsy" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Pathology and microbiology results for suspected spondylodiscitis on MR imaging are often negative in up to 70% of cases. We aimed to predict whether MR imaging features will add diagnostic value when combined with clinical biomarkers to predict positive findings of spondylodiscitis on pathology and/or microbiology from percutaneous biopsy.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;In this retrospective single-center institutional review board–approved study, patients with radiologically suspected spondylodiscitis and having undergone percutaneous biopsies were assessed. Demographic characteristics, laboratory values, and tissue and blood cultures were collected. Pathology and microbiology results were used as end points. Three independent observers provided MR imaging–based scoring for typical MR imaging features for spondylodiscitis. Multivariate logistic regression and receiver operating characteristic analysis were performed to determine an optimal combination of imaging and clinical biomarkers in predicting positive findings on pathology and/or microbiology from percutaneous biopsy suggestive of spondylodiscitis.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;Our patient cohort consisted of 72 patients, of whom 33.3% (24/72) had spondylodiscitis. The mean age was 63 ± 16 years with a male/female ratio of 41:31. Logistic regression revealed a combination with an area under the curve of 0.72 for pathology and 0.68 for pathology and/or microbiology. Epidural enhancement on MR imaging improved predictive performance to 0.87 for pathology and 0.78 for pathology and/or microbiology.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;Our findings demonstrate that epidural enhancement on MR imaging added diagnostic value when combined with clinical biomarkers to help predict which patients undergoing percutaneous biopsy will have positive findings for spondylodiscitis on pathology and/or microbiology.&lt;/p&gt;" />
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<meta name="citation_reference" content="citation_journal_title=RadioGraphics;citation_journal_abbrev=RadioGraphics;citation_author=SH. Hong;citation_author=JY. Choi;citation_author=JW. Lee;citation_title=MR Imaging Assessment of the Spine: Infection or an Imitation?1;citation_pages=599-612;citation_volume=29;citation_year=2009;citation_issue=2;citation_pmid=19325068;citation_doi=10.1148/rg.292085137" />
<meta name="citation_reference" content="citation_journal_title=Eur Spine J;citation_author=RM. Duarte;citation_author=AR. Vaccaro;citation_title=Spinal infection: State of the art and management algorithm;citation_pages=2787-99;citation_volume=22;citation_year=2013;citation_pmid=23756630;citation_doi=10.1007/s00586-013-2850-1" />
<meta name="citation_reference" content="citation_journal_title=European journal of radiology;citation_journal_abbrev=Eur J Radiol;citation_author=JK. Sehn;citation_author=LA. Gilula;citation_title=Percutaneous needle biopsy in diagnosis and identification of causative organisms in cases of suspected vertebral osteomyelitis.;citation_pages=940-946;citation_volume=81;citation_year=2012;citation_issue=5;citation_pmid=21458940;citation_doi=10.1016/j.ejrad.2011.01.125" />
<meta name="citation_reference" content="citation_journal_title=Acta Neuropathol;citation_author=HF. van Thuijl;citation_author=T. Mazor;citation_author=BE. Johnson;citation_title=Evolution of DNA repair defects during malignant progression of low-grade gliomas after temozolomide treatment;citation_pages=597-607;citation_volume=129;citation_year=2015;citation_pmid=25724300;citation_doi=10.1007/s00401-015-1403-6" />
<meta name="citation_reference" content="citation_journal_title=Radiology;citation_journal_abbrev=Radiology;citation_author=FS. Chew;citation_author=MJ. Kline;citation_title=Diagnostic Yield of CT-guided Percutaneous Aspiration Procedures in Suspected Spontaneous Infectious Diskitis;citation_pages=211-214;citation_volume=218;citation_year=2001;citation_issue=1;citation_pmid=11152804;citation_doi=10.1148/radiology.218.1.r01ja06211" />
<meta name="citation_reference" content="citation_journal_title=European spine journal :  official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society;citation_journal_abbrev=Eur Spine J;citation_author=E. Rimondi;citation_author=EL. Staals;citation_author=C. Errani;citation_title=Percutaneous CT-guided biopsy of the spine: results of 430 biopsies.;citation_pages=975-981;citation_volume=17;citation_year=2008;citation_issue=7;citation_pmid=18463900;citation_doi=10.1007/s00586-008-0678-x" />
<meta name="citation_reference" content="citation_journal_title=J Neurosci Rural Pract;citation_author=A. Landi;citation_author=G. Grasso;citation_author=G. Iaiani;citation_title=Spontaneous spinal discitis and spondylodiscitis: clinicotherapeutic remarks;citation_pages=42-46;citation_volume=8;citation_year=2017;citation_pmid=29204028;citation_doi=10.4103/jnrp.jnrp_67_17]" />
<meta name="citation_reference" content="citation_journal_title=Semin Arthritis Rheum;citation_author=V. Dufour;citation_author=A. Feydy;citation_author=L. Rillardon;citation_title=Comparative study of postoperative and spontaneous pyogenic spondylodiscitis;citation_pages=766;citation_volume=4;citation_year=2005;citation_pmid=15846593;citation_doi=10.1016/j.semarthrit.2004.08.004" />
<meta name="citation_reference" content="citation_journal_title=Seminars in arthritis and rheumatism;citation_journal_abbrev=Semin Arthritis Rheum;citation_author=G. Euba;citation_author=JA. Narváez;citation_author=JM. Nolla;citation_title=Long-term clinical and radiological magnetic resonance imaging outcome of abscess-associated spontaneous pyogenic vertebral osteomyelitis under conservative management.;citation_pages=28-40;citation_volume=38;citation_year=2008;citation_issue=1;citation_pmid=18055000;citation_doi=10.1016/j.semarthrit.2007.08.007" />
<meta name="citation_reference" content="citation_journal_title=J Antimicrob Chemother;citation_author=T. Gouliouris;citation_author=SH. Aliyu;citation_author=NM. Brown;citation_title=Spondylodiscitis: update on diagnosis and management;citation_volume=65;citation_year=2010;citation_pmid=20876624;citation_doi=10.1093/jac/dkq303" />
<meta name="citation_reference" content="citation_journal_title=Clin Orthop Relat Res;citation_author=MJ. Patzakis;citation_author=S. Rao;citation_author=J. Wilkins;citation_title=Analysis of 61 cases of vertebral osteomyelitis;citation_pages=178-83;citation_volume=264;citation_year=1991;citation_pmid=1997233" />
<meta name="citation_reference" content="citation_journal_title=Clin Orthop Rel Res;citation_author=HS. An;citation_author=JA. Seldomridge;citation_title=Spinal infections: diagnostic tests and imaging studies;citation_pages=27-33;citation_volume=443;citation_year=2006;citation_pmid=16523124;citation_doi=10.1097/01.blo.0000203452.36522.97" />
<meta name="citation_reference" content="citation_journal_title=Seminars in arthritis and rheumatism;citation_journal_abbrev=Semin Arthritis Rheum;citation_author=JM. Nolla;citation_author=J. Ariza;citation_author=C. Gómez-Vaquero;citation_title=Spontaneous pyogenic vertebral osteomyelitis in nondrug users.;citation_pages=271-278;citation_volume=31;citation_year=2002;citation_issue=4;citation_pmid=11836660;citation_doi=10.1053/sarh.2002.29492" />
<meta name="citation_reference" content="citation_journal_title=Seminars in arthritis and rheumatism;citation_journal_abbrev=Semin Arthritis Rheum;citation_author=E. Mylona;citation_author=M. Samarkos;citation_author=E. Kakalou;citation_title=Pyogenic vertebral osteomyelitis: a systematic review of clinical characteristics.;citation_pages=10-17;citation_volume=39;citation_year=2009;citation_issue=1;citation_pmid=18550153;citation_doi=10.1016/j.semarthrit.2008.03.002" />
<meta name="citation_reference" content="citation_journal_title=Arch Orthop Trauma Surg;citation_author=DC. Wirtz;citation_author=I. Genius;citation_author=JE. Wildberger;citation_title=Diagnostic and therapeutic management of lumbar and thoracic spondylodiscitis: an evaluation of 59 cases;citation_pages=245-51;citation_volume=120;citation_year=2000;citation_pmid=10853888;citation_doi=10.1007/s004020050457" />
<meta name="citation_reference" content="citation_journal_title=Annals of the Rheumatic Diseases;citation_journal_abbrev=Ann Rheum Dis;citation_author=JD. Colmenero;citation_author=ME. Jiménez-Mejías;citation_author=FJ. Sánchez-Lora;citation_title=Pyogenic, tuberculous, and brucellar vertebral osteomyelitis: a descriptive and comparative study of 219 cases;citation_pages=709-715;citation_volume=56;citation_year=1997;citation_issue=12;citation_pmid=9496149;citation_doi=10.1136/ard.56.12.709" />
<meta name="citation_reference" content="citation_journal_title=Scandinavian journal of infectious diseases;citation_journal_abbrev=Scand J Infect Dis;citation_author=M. Beronius;citation_author=B. Bergman;citation_author=R. Andersson;citation_title=Vertebral osteomyelitis in Goteborg, Sweden: a retrospective study of patients during 1990-95.;citation_pages=527-532;citation_volume=33;citation_year=2001;citation_issue=7;citation_pmid=11515764;citation_doi=10.1080/00365540110026566" />
<meta name="citation_reference" content="citation_journal_title=Journal of Orthopaedic Surgery;citation_journal_abbrev=J Orthop Surg (Hong Kong);citation_author=A. Nather;citation_author=V. David;citation_author=HT. Hee;citation_title=Pyogenic Vertebral Osteomyelitis: A Review of 14 Cases;citation_pages=240-244;citation_volume=13;citation_year=2005;citation_issue=3;citation_pmid=16365486;citation_doi=10.1177/230949900501300305" />
<meta name="citation_reference" content="citation_journal_title=Can Assoc Radiol J;citation_author=M. Sertic;citation_author=L. Parkes;citation_author=S. Mattiassi;citation_title=The Efficacy of Computed Tomography-Guided Percutaneous Spine Biopsies in Determining a Causative Organism in Cases of Suspected Infection: A Systematic Review;citation_pages=96-103;citation_volume=70;citation_year=2019;citation_pmid=30691569;citation_doi=10.1016/j.carj.2018.09.003" />
<meta name="citation_reference" content="citation_journal_title=Reviews of infectious diseases;citation_journal_abbrev=Rev Infect Dis;citation_author=FL. Sapico;citation_author=JZ. Montgomerie;citation_title=Pyogenic vertebral osteomyelitis: report of nine cases and review of the literature.;citation_pages=754-776;citation_volume=1;citation_year=1979;citation_issue=5;citation_pmid=542761;citation_doi=10.1093/clinids/1.5.754" />
<meta name="citation_reference" content="citation_journal_title=Clin Infect Dis;citation_author=AJ. Torda;citation_author=T. Gottlieb;citation_author=R. Bradbury;citation_title=Pyogenic vertebral osteomyelitis: analysis of 20 cases and review;citation_volume=20;citation_year=1995;citation_pmid=7742437;citation_doi=10.1093/clinids/20.2.320" />
<meta name="citation_reference" content="citation_journal_title=Spine (Phila Pa 1976);citation_author=LI. Sakkas;citation_author=EM. Davas;citation_author=E. Kapsalaki;citation_title=Hematogenous spinal infection in Central Greece;citation_pages=513E-18;citation_volume=34;citation_year=2009;citation_pmid=19564756;citation_doi=10.1097/BRS.0b013e3181a9897e" />
<meta name="citation_reference" content="citation_journal_title=Rheumatology;citation_author=V. Zarrouk;citation_author=A. Feydy;citation_author=F. Sallès;citation_title=Imaging does not predict the clinical outcome of bacterial vertebral osteomyelitis;citation_volume=46;citation_year=2006;citation_pmid=16877464;citation_doi=10.1093/rheumatology/kel228" />
<meta name="citation_reference" content="citation_journal_title=PLoS One;citation_author=D. Spira;citation_author=T. Germann;citation_author=B. Lehner;citation_title=CT-guided biopsy in suspected spondylodiscitis: the association of paravertebral inflammation with microbial pathogen detection;citation_pages=e0146399;citation_volume=11;citation_year=2016;citation_pmid=26727377;citation_doi=10.1371/journal.pone.0146399" />
<meta name="citation_reference" content="citation_journal_title=American Journal of Neuroradiology;citation_journal_abbrev=Am. J. Neuroradiol.;citation_author=D. Schellinger;citation_title=Patterns of anterior spinal canal involvement by neoplasms and infections;citation_pages=953-959;citation_volume=17;citation_year=1996;citation_issue=5;citation_pmid=8733973" />
<meta name="citation_reference" content="citation_journal_title=European radiology;citation_journal_abbrev=Eur Radiol;citation_author=M. Longo;citation_author=F. Granata;citation_author=GK. Ricciardi;citation_title=Contrast-enhanced MR imaging with fat suppression in adult-onset septic spondylodiscitis.;citation_pages=626-637;citation_volume=13;citation_year=2003;citation_issue=3;citation_pmid=12594568;citation_doi=10.1007/s00330-002-1411-5" />
<meta name="citation_reference" content="citation_journal_title=World Neurosurg;citation_author=SC. Foreman;citation_author=BJ. Schwaiger;citation_author=J. Gempt;citation_title=MR and CT imaging to optimize CT-guided biopsies in suspected spondylodiscitis;citation_pages=726-34.e7;citation_volume=99;citation_year=2017;citation_pmid=27840205;citation_doi=10.1016/j.wneu.2016.11.017]" />
<meta name="citation_reference" content="citation_journal_title=Korean J Spine;citation_author=KH. Nam;citation_author=GS. Song;citation_author=IH. Han;citation_title=Diagnostic value of biopsy techniques in lumbar spondylodiscitis: percutaneous needle biopsy and open biopsy;citation_pages=267-71;citation_volume=8;citation_year=2011;citation_pmid=26064144;citation_doi=10.14245/kjs.2011.8.4.267" />
<meta name="twitter:title" content="Combination of Imaging Features and Clinical Biomarkers Predicts Positive Pathology and Microbiology Findings Suggestive of Spondylodiscitis in Patients Undergoing Image-Guided Percutaneous Biopsy" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Pathology and microbiology results for suspected spondylodiscitis on MR imaging are often negative in up to 70% of cases. We aimed to predict whether MR imaging features will add diagnostic value when combined with clinical biomarkers to predict positive findings of spondylodiscitis on pathology and/or microbiology from percutaneous biopsy.

MATERIALS AND METHODS: In this retrospective single-center institutional review board–approved study, patients with radiologically suspected spondylodiscitis and having undergone percutaneous biopsies were assessed. Demographic characteristics, laboratory values, and tissue and blood cultures were collected. Pathology and microbiology results were used as end points. Three independent observers provided MR imaging–based scoring for typical MR imaging features for spondylodiscitis. Multivariate logistic regression and receiver operating characteristic analysis were performed to determine an optimal combination of imaging and clinical biomarkers in predicting positive findings on pathology and/or microbiology from percutaneous biopsy suggestive of spondylodiscitis.

RESULTS: Our patient cohort consisted of 72 patients, of whom 33.3% (24/72) had spondylodiscitis. The mean age was 63 ± 16 years with a male/female ratio of 41:31. Logistic regression revealed a combination with an area under the curve of 0.72 for pathology and 0.68 for pathology and/or microbiology. Epidural enhancement on MR imaging improved predictive performance to 0.87 for pathology and 0.78 for pathology and/or microbiology.

CONCLUSIONS: Our findings demonstrate that epidural enhancement on MR imaging added diagnostic value when combined with clinical biomarkers to help predict which patients undergoing percutaneous biopsy will have positive findings for spondylodiscitis on pathology and/or microbiology.

AUC
:   area under the curve
CRP
:   C-reactive protein
ESR
:   erythrocyte sedimentation rate
NPV
:   negative predictive value
PPV
:   positive predictive value" />
<meta name="og-title" property="og:title" content="Combination of Imaging Features and Clinical Biomarkers Predicts Positive Pathology and Microbiology Findings Suggestive of Spondylodiscitis in Patients Undergoing Image-Guided Percutaneous Biopsy" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/41/7/1316" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: Pathology and microbiology results for suspected spondylodiscitis on MR imaging are often negative in up to 70% of cases. We aimed to predict whether MR imaging features will add diagnostic value when combined with clinical biomarkers to predict positive findings of spondylodiscitis on pathology and/or microbiology from percutaneous biopsy.

MATERIALS AND METHODS: In this retrospective single-center institutional review board–approved study, patients with radiologically suspected spondylodiscitis and having undergone percutaneous biopsies were assessed. Demographic characteristics, laboratory values, and tissue and blood cultures were collected. Pathology and microbiology results were used as end points. Three independent observers provided MR imaging–based scoring for typical MR imaging features for spondylodiscitis. Multivariate logistic regression and receiver operating characteristic analysis were performed to determine an optimal combination of imaging and clinical biomarkers in predicting positive findings on pathology and/or microbiology from percutaneous biopsy suggestive of spondylodiscitis.

RESULTS: Our patient cohort consisted of 72 patients, of whom 33.3% (24/72) had spondylodiscitis. The mean age was 63 ± 16 years with a male/female ratio of 41:31. Logistic regression revealed a combination with an area under the curve of 0.72 for pathology and 0.68 for pathology and/or microbiology. Epidural enhancement on MR imaging improved predictive performance to 0.87 for pathology and 0.78 for pathology and/or microbiology.

CONCLUSIONS: Our findings demonstrate that epidural enhancement on MR imaging added diagnostic value when combined with clinical biomarkers to help predict which patients undergoing percutaneous biopsy will have positive findings for spondylodiscitis on pathology and/or microbiology.

AUC
:   area under the curve
CRP
:   C-reactive protein
ESR
:   erythrocyte sedimentation rate
NPV
:   negative predictive value
PPV
:   positive predictive value" />
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    <title>Combination of Imaging Features and Clinical Biomarkers Predicts Positive Pathology and Microbiology Findings Suggestive of Spondylodiscitis in Patients Undergoing Image-Guided Percutaneous Biopsy | American Journal of Neuroradiology</title>  
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    <div class="highwire-article-citation highwire-citation-type-highwire-article node76582--5" data-node-nid="76582" id="top-node-76582--6862169202" data-pisa="ajnr;41/7/1316" data-pisa-master="ajnr;ajnr.A6623" data-apath="/ajnr/41/7/1316.atom" data-hw-author-tooltip-instance="highwire_author_tooltip"><div class="highwire-cite highwire-cite-highwire-article highwire-citation-jcore-article-title-complete clearfix has-author-tooltip highwire-citation-highwire-article-top-a">
  
  
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      <h1 class="highwire-cite-title" id="page-title">Combination of Imaging Features and Clinical Biomarkers Predicts Positive Pathology and Microbiology Findings Suggestive of Spondylodiscitis in Patients Undergoing Image-Guided Percutaneous Biopsy</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">S. Kihira</span>, <span class="highwire-citation-author" data-delta="1">C. Koo</span>, <span class="highwire-citation-author" data-delta="2">K. Mahmoudi</span>, <span class="highwire-citation-author" data-delta="3">T. Leong</span>, <span class="highwire-citation-author" data-delta="4">X. Mei</span>, <span class="highwire-citation-author" data-delta="5">B. Rigney</span>, <span class="highwire-citation-author" data-delta="6">A. Aggarwal</span> and <span class="highwire-citation-author" data-delta="7">A.H. Doshi</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">July 2020,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">41 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(7) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1316-1322; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A6623 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-76582--6862169202" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">S. Kihira </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=S.%2BKihira%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Kihira%20S&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AS.%2BKihira%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0003-1001-8741" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for S. Kihira</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">C. Koo </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=C.%2BKoo%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Koo%20C&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AC.%2BKoo%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0001-8620-7990" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for C. Koo</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">K. Mahmoudi </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=K.%2BMahmoudi%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Mahmoudi%20K&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AK.%2BMahmoudi%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-2002-5710" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for K. Mahmoudi</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">T. Leong </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=T.%2BLeong%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Leong%20T&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AT.%2BLeong%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0001-7564-5741" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for T. Leong</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">X. Mei </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=X.%2BMei%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Mei%20X&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AX.%2BMei%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0001-7224-7318" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for X. Mei</a></li></ul></div><div class="author-tooltip-5"><div class="author-tooltip-name">B. Rigney </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=B.%2BRigney%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Rigney%20B&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AB.%2BRigney%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-5886-1423" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for B. Rigney</a></li></ul></div><div class="author-tooltip-6"><div class="author-tooltip-name">A. Aggarwal </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=A.%2BAggarwal%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Aggarwal%20A&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AA.%2BAggarwal%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-9562-6457" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for A. Aggarwal</a></li></ul></div><div class="author-tooltip-7"><div class="author-tooltip-name">A.H. Doshi </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=A.H.%2BDoshi%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Doshi%20A&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AA.H.%2BDoshi%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-2507-436X" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for A.H. 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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" data-highwire-cite-ref-tooltip-instance="highwire_reflinks_tooltip" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="article abstract-view "><span class="highwire-journal-article-marker-start"></span><div class="section abstract" id="abstract-1"><h2>Abstract</h2><div id="sec-1" class="subsection"><p id="p-1"><strong>BACKGROUND AND PURPOSE:</strong> Pathology and microbiology results for suspected spondylodiscitis on MR imaging are often negative in up to 70% of cases. We aimed to predict whether MR imaging features will add diagnostic value when combined with clinical biomarkers to predict positive findings of spondylodiscitis on pathology and/or microbiology from percutaneous biopsy.</p></div><div id="sec-2" class="subsection"><p id="p-2"><strong>MATERIALS AND METHODS:</strong> In this retrospective single-center institutional review board–approved study, patients with radiologically suspected spondylodiscitis and having undergone percutaneous biopsies were assessed. Demographic characteristics, laboratory values, and tissue and blood cultures were collected. Pathology and microbiology results were used as end points. Three independent observers provided MR imaging–based scoring for typical MR imaging features for spondylodiscitis. Multivariate logistic regression and receiver operating characteristic analysis were performed to determine an optimal combination of imaging and clinical biomarkers in predicting positive findings on pathology and/or microbiology from percutaneous biopsy suggestive of spondylodiscitis.</p></div><div id="sec-3" class="subsection"><p id="p-3"><strong>RESULTS:</strong> Our patient cohort consisted of 72 patients, of whom 33.3% (24/72) had spondylodiscitis. The mean age was 63 ± 16 years with a male/female ratio of 41:31. Logistic regression revealed a combination with an area under the curve of 0.72 for pathology and 0.68 for pathology and/or microbiology. Epidural enhancement on MR imaging improved predictive performance to 0.87 for pathology and 0.78 for pathology and/or microbiology.</p></div><div id="sec-4" class="subsection"><p id="p-4"><strong>CONCLUSIONS:</strong> Our findings demonstrate that epidural enhancement on MR imaging added diagnostic value when combined with clinical biomarkers to help predict which patients undergoing percutaneous biopsy will have positive findings for spondylodiscitis on pathology and/or microbiology.</p></div></div><div class="section glossary" id="glossary-1"><h2 class="">ABBREVIATIONS:</h2><dl id="def-list-1"><dt id="def-item-1">AUC<span class="def-item-dt-sep"></span></dt><dd>area under the curve<span class="def-item-dd-sep"></span></dd><dt id="def-item-2">CRP<span class="def-item-dt-sep"></span></dt><dd>C-reactive protein<span class="def-item-dd-sep"></span></dd><dt id="def-item-3">ESR<span class="def-item-dt-sep"></span></dt><dd>erythrocyte sedimentation rate<span class="def-item-dd-sep"></span></dd><dt id="def-item-4">NPV<span class="def-item-dt-sep"></span></dt><dd>negative predictive value<span class="def-item-dd-sep"></span></dd><dt id="def-item-5">PPV<span class="def-item-dt-sep"></span></dt><dd>positive predictive value</dd></dl></div><ul class="copyright-statement"><li class="fn" id="copyright-statement-1">© 2020 by American Journal of Neuroradiology</li></ul><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div><a href="http://ajnr-stage2.stage.highwire.org/content/41/7/1316.full" class="hw-link hw-link-article-full-text" data-icon-position="" data-hide-link-title="0">View Full Text</a></div>  </div>

  
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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 41</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 7 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 Jul 2020 </div></div>
      
      
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    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Jul 2020, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">41 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(7) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1316-1322; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A6623 </span></div>
  
  
  
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