Abstract
BackgroundAlthough MRI is the gold-standard imaging method in the diagnosis of spondylodiscitis, role of follow-up imaging is debated and there can be discrepancies with regard to the significance of bony or soft tissue responses to treatment. Purpose of our study is to test whether the MRI changes on follow-up imaging correlate with laboratory findings of treatment response.MethodsA total of 48 patients with pyogenic spondylodiscitis who underwent baseline and follow-up MRI were retrospectively reviewed. The extent of bone marrow edema, paravertebral soft tissue inflammation, and disc height were compared on baseline and follow-up MRIs with the C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) levels obtained from the medical records at baseline and on follow-up. Relationships between the MRI and laboratory changes were analyzed using the Spearmann correlation test.ResultsThe mean MRI follow-up period was 42.25 days. Based on the CRP (resolved: n = 19, resolving: n = 19, and aggravated: n = 10), there was significant correlation between the laboratory results and the changes in the bone and soft tissues (p < 0.01, both). The correlation was best with soft tissue changes (rho: 0.48) followed by bony changes (rho: 0.41). Based on the ESR (resolved: n = 8, resolving: n = 22, and worsened: n = 18), the correlation was stronger with bone changes (rho: 0.45, p < 0.01) than it was with soft tissue changes (rho: 0.39, p = 0.01).ConclusionFollow-up MRI findings of pyogenic spondylodiscitis show variable tissue responses. CRP was best correlated with soft tissue changes, while ESR showed the best association with bony changes.
Highlights
Magnetic resonance imaging (MRI) is the gold-standard imaging method in the diagnosis of spondylodiscitis, role of follow-up imaging is debated and there can be discrepancies with regard to the significance of bony or soft tissue responses to treatment
In this study, we evaluated the relationship between follow-up MRI findings of specific tissues and laboratory results in pyogenic spondylodiscitis
C-reactive protein (CRP) was best correlated with soft tissue changes, while erythrocyte sedimentation rate (ESR) was best correlated with bone changes
Summary
MRI is the gold-standard imaging method in the diagnosis of spondylodiscitis, role of follow-up imaging is debated and there can be discrepancies with regard to the significance of bony or soft tissue responses to treatment. Purpose of our study is to test whether the MRI changes on follow-up imaging correlate with laboratory findings of treatment response. The characteristic MRI findings of spondylodiscitis (upon the bone, disc, and surrounding soft tissues including the epidural space) have been described previously. Some of these features include edema in the disc or vertebral body, erosions or destruction of the vertebral endplate, and. Some groups suggest that the soft tissue findings are more reliable markers of therapeutic response than are bony changes [9,10,11]
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