Diagnostic Yield of Fluoroscopy-Guided Biopsy for Infectious Spondylitis [SP...

 

 

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Diagnostic Yield of Fluoroscopy-Guided Biopsy for Infectious Spondylitis [SPINE]

via Publication Preview by Kim, B. J., Lee, J. W., Kim, S. J., Lee, G. Y., Kang, H. S. on 5/24/12

BACKGROUND AND PURPOSE:

CT is currently the method of choice for guiding biopsy of lesions of the spine. However, in our hospital, fluoroscopy-guided percutaneous biopsy has been preferred for several years because of equipment availability and easy craniocaudal angulation. The aim of this study was to evaluate the efficacy of fluoroscopy-guided percutaneous biopsy in a clinical setting for diagnosing infectious spondylitis.

MATERIALS AND METHODS:

A retrospective study was performed to evaluate 170 fluoroscopy-guided percutaneous biopsies in 140 patients (male/female = 70:70; mean age, 65.1 years; range, 16–89 years) in a clinical setting who were suspected of having infectious spondylitis between July 2003 and March 2010. Diagnosis was based on pathologic confirmation by tissue or culture from biopsy. The percentage of adequate specimens for diagnosis, histopathologic diagnosis for infectious spondylitis, and positive cultures for causative organisms were evaluated by retrospective review of medical records.

RESULTS:

Adequate specimens for diagnosis were obtained in 165 of 170 cases (97.1%). The diagnosis of infectious spondylitis resulted in 134 of 170 cases confirmed through histopathology or clinical outcome (78.8%). In 51 of 134 cases (38.1%), the causative organism was confirmed by specimens from percutaneous bone biopsy. There were no biopsy-related major complications. The most common organism isolated was Mycobacterium tuberculosis (24 cases), followed by Staphylococcus aureus, Streptococcus agalactiae, and Streptococcus viridans.

CONCLUSIONS:

Fluoroscopy-guided percutaneous biopsy is as accurate and effective as CT-guided biopsy for diagnosing infectious spondylitis.

 

 

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Seizures on the morning of admission

Vitals stable

No focal deficit

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NCCT at admission

Enlarged images of the NCCT

A cerebral DSA was done which showed thrombosis of anterior part of the superior sagittal sinus, partial thrombosis of the inferior sagittal sinus with hypoplastic left transverse and sigmoid sinuses

Right ICA angiogram

Left ICA angiogram

Left and right vertebral angiogram

Right middle meningeal had anomalous origin from right petrous ICA

Left ECA angiogram showed blush from the middle meningeal artery in the region of the thrombosed superior sagittal sinus

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Enlarged images of the NCCT

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The myelogram showed partial obstruction to the contrast flow however the compression was not extremely severe. The patient was operated and the spine fixed.

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MRI showing diffusion restriction in left MCA territory

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The TCD wave at the end of the procedure ( 2 hours)

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Cases in this blog....click on the link to open the full case page

1. PET picks up Rasmussen's encephalitis before CT/MRI: http://neuroradiologyindia.blogspot.in/2010/06/pet-picks-up-rasmussens-encephalitis.html
2. A strange case of tuberculosis: http://neuroradiologyindia.blogspot.in/2009/11/strange-case-of-tuberculosis.html
3. A young man with vision loss: Adrenoleukodystrophy: http://neuroradiologyindia.blogspot.in/2009/11/young-man-with-vision-loss.html
4. An elderly gentleman with inability to hold urine: normal pressure hydrocephalus: http://neuroradiologyindia.blogspot.in/2009/10/urine.html
5. Tractography finds unseen lesions in a casae of cortical dysplasia: http://neuroradiologyindia.blogspot.in/2009/07/tractography-finds-unseen-lesions-in.html
6. Chronic multiple sclerosis: http://neuroradiologyindia.blogspot.in/2009/07/chronic-multiple-sclerosis.html
7. Tractography in right frontal glioma: http://neuroradiologyindia.blogspot.in/2009/07/tractography-in-right-frontal-glioma.html

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