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Can gas and infection coexist in the intervertebral disc? A retrospective analysis of percutaneously biopsied suspected discitis-osteomyelitis cases

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Abstract

Objectives

To retrospectively evaluate the correlation between intradiscal gas and infection in patients percutaneously biopsied for suspected discitis-osteomyelitis.

Materials and methods

We retrospectively reviewed all CT-guided discitis-osteomyelitis biopsies performed between 2002 and 2022. Two independent trained musculoskeletal radiologists evaluated for presence of gas on CT and/or MRI within 1 week of the biopsy. Disagreements were resolved by a third musculoskeletal radiologist. CT was considered the gold standard for the detection of intradiscal gas. Pathology, microbiology, and imaging and clinical follow-up were used as the gold standard for presence of infection. Interrater agreement on CT and MRI, sensitivity, and positive predictive value were calculated, using the presence of gas as an indicator (test positive) for “no infection.”

Results

There were 284 biopsies in 275 subjects (mean age 58 ± 1.0 (range 4–99) years; 101 (37%) females and 174 (63%) males). Of the biopsies, 12 (4%) were cervical, 80 (28%) were thoracic, 192 (68%) were lumbar, and 200 (70%) were considered true discitis-osteomyelitis based on pathology, imaging, and clinical follow-up. Interrater agreement was excellent for CT (kappa = 0.83) and poor for MRI (kappa =  − 0.021). The presence of gas had a 94% specificity and 76% negative predictive value for the absence of infection.

Conclusion

CT is the preferred method for detecting intradiscal gas. The presence of gas means that discitis-osteomyelitis is unlikely. If intradiscal gas is present in the setting of discitis-osteomyelitis, the gas bubbles tend to be smaller and fewer in number.

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Authors and Affiliations

  1. Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA

    Jad S. Husseini, Arnau Hanly, Emre Omeroglu, F. Joseph Simeone & Connie Y. Chang

  2. Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA

    Sandra B. Nelson

  3. Department of Radiology, University of Colorado, Aurora, CO, USA

    Mary Kate Jesse

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  1. Jad S. Husseini
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  2. Arnau Hanly
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Correspondence to Connie Y. Chang.

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Ethical approval

All procedures performed in studies involving human subjects were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved by the MassGeneral Brigham (MGB) Human Research IRB (Protocol #: 2020P003048).

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The study was approved by the local Institutional Review Board (IRB) and HIPAA compliant. Verbal consent for participation in the study was waived due to retrospective study design.

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Husseini, J.S., Hanly, A., Omeroglu, E. et al. Can gas and infection coexist in the intervertebral disc? A retrospective analysis of percutaneously biopsied suspected discitis-osteomyelitis cases. Skeletal Radiol (2024). https://doi.org/10.1007/s00256-024-04631-5

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  • DOI: https://doi.org/10.1007/s00256-024-04631-5

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