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The Diagnostic Performance of Multi-Detector Computed Tomography (MDCT) in Depiction of Acute Spondylodiscitis in an Emergency Department

Background: The diagnosis of acute spondylodiscitis can be very difficult because clinical onset symptoms are highly variable. The reference examination is MRI, but very often the first diagnostic investigation performed is CT, given its high availability in the acute setting. CT allows rapid evalua...

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Autores principales: Negro, Alberto, Somma, Francesco, Tortora, Mario, Lugarà, Marina, Tamburrini, Stefania, Coppola, Maria Gabriella, Piscitelli, Valeria, Fasano, Fabrizio, Sicignano, Carmine, Vargas, Ottavia, Pace, Gianvito, Giardiello, Mariarosaria, Iannuzzi, Michele, Toro, Gabriella, De Simone, Fiore, Catalano, Marco, Carbone, Roberto, Rocco, Concetta, Saturnino, Pietro Paolo, Della Gatta, Luigi, Villa, Alessandro, Tortora, Fabio, Gemini, Laura, Caranci, Ferdinando, D’Agostino, Vincenzo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9332551/
https://www.ncbi.nlm.nih.gov/pubmed/35894025
http://dx.doi.org/10.3390/tomography8040160
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author Negro, Alberto
Somma, Francesco
Tortora, Mario
Lugarà, Marina
Tamburrini, Stefania
Coppola, Maria Gabriella
Piscitelli, Valeria
Fasano, Fabrizio
Sicignano, Carmine
Vargas, Ottavia
Pace, Gianvito
Giardiello, Mariarosaria
Iannuzzi, Michele
Toro, Gabriella
De Simone, Fiore
Catalano, Marco
Carbone, Roberto
Rocco, Concetta
Saturnino, Pietro Paolo
Della Gatta, Luigi
Villa, Alessandro
Tortora, Fabio
Gemini, Laura
Caranci, Ferdinando
D’Agostino, Vincenzo
author_facet Negro, Alberto
Somma, Francesco
Tortora, Mario
Lugarà, Marina
Tamburrini, Stefania
Coppola, Maria Gabriella
Piscitelli, Valeria
Fasano, Fabrizio
Sicignano, Carmine
Vargas, Ottavia
Pace, Gianvito
Giardiello, Mariarosaria
Iannuzzi, Michele
Toro, Gabriella
De Simone, Fiore
Catalano, Marco
Carbone, Roberto
Rocco, Concetta
Saturnino, Pietro Paolo
Della Gatta, Luigi
Villa, Alessandro
Tortora, Fabio
Gemini, Laura
Caranci, Ferdinando
D’Agostino, Vincenzo
author_sort Negro, Alberto
collection PubMed
description Background: The diagnosis of acute spondylodiscitis can be very difficult because clinical onset symptoms are highly variable. The reference examination is MRI, but very often the first diagnostic investigation performed is CT, given its high availability in the acute setting. CT allows rapid evaluation of other alternative diagnoses (e.g., fractures), but scarce literature is available to evaluate the accuracy of CT, and in particular of multi-detector computed tomography (MDCT), in the diagnosis of suspected spondylodiscitis. The aim of our study was to establish MDCT accuracy and how this diagnostic method could help doctors in the depiction of acute spondylodiscitis in an emergency situation by comparing the diagnostic performance of MDCT with MRI, which is the gold standard. Methods: We searched our radiological archive for all MRI examinations of patients who had been studied for a suspicion of acute spondylodiscitis in the period between January 2017 and January 2021 (n = 162). We included only patients who had undergone MDCT examination prior to MRI examination (n = 25). The overall diagnostic value of MDCT was estimated, using MRI as the gold standard. In particular, the aim of our study was to clarify the effectiveness of CT in radiological cases that require immediate intervention (stage of complications). Therefore, the radiologist, faced with a negative CT finding, can suggest an elective (not urgent) MRI with relative serenity and without therapeutic delays. Results: MDCT allowed identification of the presence of acute spondylodiscitis in 13 of 25 patients. Specificity and positive predictive value were 100% for MDCT, while sensitivity and negative predictive value were 68% and 50%, respectively, achieving an overall accuracy of 76%. In addition, MDCT allowed the identification of paravertebral abscesses (92%), fairly pathognomonic lesions of spondylodiscitis pathology. Conclusions: The MDCT allows identification of the presence of acute spondylodiscitis in the Emergency Department (ED) with a satisfactory accuracy. In the case of a positive CT examination, this allows therapy to be started immediately and reduces complications. However, we suggest performing an elective MRI examination in negative cases in which pathological findings are hard to diagnose with CT alone.
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spelling pubmed-93325512022-07-29 The Diagnostic Performance of Multi-Detector Computed Tomography (MDCT) in Depiction of Acute Spondylodiscitis in an Emergency Department Negro, Alberto Somma, Francesco Tortora, Mario Lugarà, Marina Tamburrini, Stefania Coppola, Maria Gabriella Piscitelli, Valeria Fasano, Fabrizio Sicignano, Carmine Vargas, Ottavia Pace, Gianvito Giardiello, Mariarosaria Iannuzzi, Michele Toro, Gabriella De Simone, Fiore Catalano, Marco Carbone, Roberto Rocco, Concetta Saturnino, Pietro Paolo Della Gatta, Luigi Villa, Alessandro Tortora, Fabio Gemini, Laura Caranci, Ferdinando D’Agostino, Vincenzo Tomography Article Background: The diagnosis of acute spondylodiscitis can be very difficult because clinical onset symptoms are highly variable. The reference examination is MRI, but very often the first diagnostic investigation performed is CT, given its high availability in the acute setting. CT allows rapid evaluation of other alternative diagnoses (e.g., fractures), but scarce literature is available to evaluate the accuracy of CT, and in particular of multi-detector computed tomography (MDCT), in the diagnosis of suspected spondylodiscitis. The aim of our study was to establish MDCT accuracy and how this diagnostic method could help doctors in the depiction of acute spondylodiscitis in an emergency situation by comparing the diagnostic performance of MDCT with MRI, which is the gold standard. Methods: We searched our radiological archive for all MRI examinations of patients who had been studied for a suspicion of acute spondylodiscitis in the period between January 2017 and January 2021 (n = 162). We included only patients who had undergone MDCT examination prior to MRI examination (n = 25). The overall diagnostic value of MDCT was estimated, using MRI as the gold standard. In particular, the aim of our study was to clarify the effectiveness of CT in radiological cases that require immediate intervention (stage of complications). Therefore, the radiologist, faced with a negative CT finding, can suggest an elective (not urgent) MRI with relative serenity and without therapeutic delays. Results: MDCT allowed identification of the presence of acute spondylodiscitis in 13 of 25 patients. Specificity and positive predictive value were 100% for MDCT, while sensitivity and negative predictive value were 68% and 50%, respectively, achieving an overall accuracy of 76%. In addition, MDCT allowed the identification of paravertebral abscesses (92%), fairly pathognomonic lesions of spondylodiscitis pathology. Conclusions: The MDCT allows identification of the presence of acute spondylodiscitis in the Emergency Department (ED) with a satisfactory accuracy. In the case of a positive CT examination, this allows therapy to be started immediately and reduces complications. However, we suggest performing an elective MRI examination in negative cases in which pathological findings are hard to diagnose with CT alone. MDPI 2022-07-26 /pmc/articles/PMC9332551/ /pubmed/35894025 http://dx.doi.org/10.3390/tomography8040160 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Negro, Alberto
Somma, Francesco
Tortora, Mario
Lugarà, Marina
Tamburrini, Stefania
Coppola, Maria Gabriella
Piscitelli, Valeria
Fasano, Fabrizio
Sicignano, Carmine
Vargas, Ottavia
Pace, Gianvito
Giardiello, Mariarosaria
Iannuzzi, Michele
Toro, Gabriella
De Simone, Fiore
Catalano, Marco
Carbone, Roberto
Rocco, Concetta
Saturnino, Pietro Paolo
Della Gatta, Luigi
Villa, Alessandro
Tortora, Fabio
Gemini, Laura
Caranci, Ferdinando
D’Agostino, Vincenzo
The Diagnostic Performance of Multi-Detector Computed Tomography (MDCT) in Depiction of Acute Spondylodiscitis in an Emergency Department
title The Diagnostic Performance of Multi-Detector Computed Tomography (MDCT) in Depiction of Acute Spondylodiscitis in an Emergency Department
title_full The Diagnostic Performance of Multi-Detector Computed Tomography (MDCT) in Depiction of Acute Spondylodiscitis in an Emergency Department
title_fullStr The Diagnostic Performance of Multi-Detector Computed Tomography (MDCT) in Depiction of Acute Spondylodiscitis in an Emergency Department
title_full_unstemmed The Diagnostic Performance of Multi-Detector Computed Tomography (MDCT) in Depiction of Acute Spondylodiscitis in an Emergency Department
title_short The Diagnostic Performance of Multi-Detector Computed Tomography (MDCT) in Depiction of Acute Spondylodiscitis in an Emergency Department
title_sort diagnostic performance of multi-detector computed tomography (mdct) in depiction of acute spondylodiscitis in an emergency department
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9332551/
https://www.ncbi.nlm.nih.gov/pubmed/35894025
http://dx.doi.org/10.3390/tomography8040160
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