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MRI and clinical features of acute fungal discitis/osteomyelitis

  • Musculoskeletal
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To compare imaging and clinical features of fungal and Staphylococcus aureus discitis-osteomyelitis (DO) for patients presenting for CT-guided biopsies.

Methods

Our study was IRB-approved and HIPAA-compliant. A group of 11 fungal DO (FG) with MRI within 7 days of the biopsy and a control group (CG) of 19 Staphylococcus aureus DO were evaluated. Imaging findings (focal vs diffuse paravertebral soft tissue abnormality, partial vs complete involvement of the disc/endplate), biopsy location, pathology, duration of back pain, immune status, history of intravenous drug, history of prior infection, current antibiotic treatment, and history of invasive intervention. Differences were assessed using the Fisher exact test and Kruskal-Wallis test. Naïve Bayes predictive modeling was performed.

Results

The most common fungal organisms were Candida species (9/11, 82%). The FG was more likely to have focal soft tissue abnormality (p = 0.040) and partial disc/endplate involvement (p = 0.053). The clinical predictors for fungal DO, in order of importance, back pain for 10 or more weeks, current antibiotic use for 1 week or more, and current intravenous drug use. History of invasive instrumentation within 1 year was more predictive of Staphylococcus aureus DO.

Conclusion

MRI features (focal partial soft tissue abnormality and partial involvement of the disc/endplate) in combination with clinical features may help to predict fungal species as a causative organism for DO.

Key Points

• MRI features of discitis-osteomyelitis (focal partial soft tissue abnormality and partial involvement of the disc/endplate) in combination with clinical features may help to predict fungal species as a causative organism for DO.

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Abbreviations

CG:

Control group

DO:

Discitis-osteomyelitis

FG:

Fungal group

MRI:

Magnetic resonance imaging

MRSA:

Methicillin-resistant Staphylococcus aureus

MSSA:

Methicillin-sensitive Staphylococcus aureus

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street – YAW 6046 –, Boston, MA, 02114, USA

    F. Joseph Simeone, Jad S. Husseini, Kaitlyn J. Yeh & Connie Y. Chang

  2. Department of Orthopedics, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02144, USA

    Santiago Lozano-Calderon

  3. Division of Infectious Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02144, USA

    Sandra B. Nelson

Authors
  1. F. Joseph Simeone
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  2. Jad S. Husseini
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  3. Kaitlyn J. Yeh
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  4. Santiago Lozano-Calderon
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  5. Sandra B. Nelson
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  6. Connie Y. Chang
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Corresponding author

Correspondence to Connie Y. Chang.

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The scientific guarantor of this publication is Connie Y. Chang.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

Two of the authors have statistical expertise.

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Written informed consent was waived by the Institutional Review Board.

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Institutional Review Board approval was obtained.

Methodology

• Retrospective

• Observational

• Performed at one institution

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Simeone, F.J., Husseini, J.S., Yeh, K.J. et al. MRI and clinical features of acute fungal discitis/osteomyelitis. Eur Radiol 30, 2253–2260 (2020). https://doi.org/10.1007/s00330-019-06603-z

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  • DOI: https://doi.org/10.1007/s00330-019-06603-z

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