Clinical suspicion of spondylodiscitis with equivocal MRI findings: does diffusion-weighted imaging prove helpful here?

Author:

Henkelmann Jeanette1ORCID,Bremicker Kristina1ORCID,Denecke Timm1,Hoffmann Karl-Titus1,Henkelmann Ralf2,Heyde Christoph-Eckhard2,Sabri Osama3,Purz Sandra3

Affiliation:

1. Department for Diagnostic and Interventional Radiology, University Hospital Leipzig, Leipzig, Germany

2. Department for Orthopedics, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany

3. Department for Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany

Abstract

Background Despite the high sensitivity of magnetic resonance imaging (MRI), early detection of spondylodiscitis (SpD) remains challenging due to its low specificity. Purpose To assess the diagnostic value of diffusion-weighted imaging (DWI) in suspected cases of SpD with ambiguous early MRI findings in the differentiation of degenerative disorders (DD). Material and Methods In this prospective study, 52 patients suspected of having SpD underwent a whole-spine 3-T MRI scan comprising sagittal DWI. Of 58 conspicuous, T2-weighted, signal increased discs, 39 were successfully evaluated using DWI. Apparent diffusion coefficient (ADC) values and ADC maps were blindly analyzed using the region of interest of the conspicuous disc and a normal adjacent reference disc. Intraindividual ratios (conspicuous disc: reference disc) were calculated. Results All conspicuous discs showed increased absolute ADC values, which did not differ significantly between SpD (n = 22) and DD (n = 17). However, ADC ratio was significantly higher in SpD vs. DD ( P < 0.05). In receiver operating characteristic curve analysis, an ADC ratio threshold of 1.6 resulted in 45% sensitivity and 88% specificity (area under the curve = 0.69) for SpD diagnosis. Conclusion The absolute ADC value does not provide a reliable diagnosis of SpD. Increased diffusivity can be an indication of infection but should always be discussed in the context of existing disc degeneration.

Publisher

SAGE Publications

Subject

Radiology, Nuclear Medicine and imaging,General Medicine,Radiological and Ultrasound Technology

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