J Korean Soc Radiol JKSR Journal of the Korean Society of Radiology 1738-2637 2288-2928 The Korean Society of Radiology 10.3348/jksr.2015.73.5.300 Musculoskeletal Radiology Image-Guided Percutaneous Needle Biopsy for Infectious Spondylitis: Factors Affecting Culture Positivity Sung Siyoun MD 1 Kwon Jong Won MD 1 2 Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Korea. Corresponding author: Jong Won Kwon, MD. Department of Radiology, Samsung Medical Center, Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea. Tel. 82-2-3410-2568, Fax. 82-2-3410-0049, jwjwkwon@gmail.com 11 2015 28 10 2015 73 5 300 306 11 05 2015 19 06 2015 10 07 2015 Copyright © 2015 The Korean Society of Radiology 2015 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Purpose

To evaluate the variable factors affecting the results of percutaneous needle biopsies for infectious spondylitis.

 Materials and Methods

In all, 249 patients who underwent both MRI and percutaneous needle biopsies due to a suspicion of infectious spondylitis were evaluated with respect to the following factors: the usage of antibiotics before the procedure, the location of the biopsy, the guiding equipment used, the experience level of the operators, and the number of biopsies performed.

 Results

The positivity of culture in cases of treated with antibiotics (16.3%) before the biopsy was lower than in the untreated cases (30.5%) (p = 0.004). Biopsies performed at the abscess (43.5%) and with fluoroscopic guidance (27.8%) showed higher culture positivity as well. The experience level of the operators and the number of biopsies had no effect on culture positivity.

 Conclusion

The usage of antibiotics before the biopsy, the biopsy's location, and the guiding equipment used affect the culture positivity, while the experience levels of the operators and the number of biopsies do not have an effect.

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A. A sagittal T2-weighted MR image shows the loss of fatty marrow signal intensity and subchondral bone destruction at the T11 and T12 vertebral bodies. A burst fracture of the T12 vertebral body is also noted.

B. Contrast-enhanced T1-weighted image shows diffuse enhancement of the T11 and T12 vertebral bodies and phlegmon at the anterior epidural space of the T12 level.

C. A percutaneous biopsy was performed at the T12 vertebral body under fluoroscopic guidance. The isolated organism was Staphylococcus aureus.

 A 68-year-old man with back pain.

A. The T2-weighted axial image shows an intraosseous abscess in the L4 vertebral body with an anterior epidural extension (arrowheads). There is also a direct extension into the left psoas muscle (arrow).

B. A percutaneous biopsy and aspiration were performed under CT guidance in the left psoas abscess. The isolated causative organism was Mycobacterium tuberculosis.

 Multivariate Logistic Regression Results for Culture Results
Culture Results p-Values
Positive (n = 62, 24.9%) Negative (n = 187, 75.1%)
Antibiotics before biopsy 0.004
 Used 16 (16.3%) 82 (83.7%)
 Not used 46 (30.5%) 105 (69.5%)
Biopsy sites < 0.001
 Abscess 20 (43.5%) 26 (56.5%)
 Disc 4 (30.8%) 9 (69.2%)
 Vertebral body 38 (20%) 152 (80%)
Guiding modality 0.005
 Fluoroscopy 44 (27.8%) 114 (72.2%)
 CT 18 (19.8%) 73 (80.2%)
Operator 0.537
 Staff 42 (25.6%) 122 (74.3%)
 Fellow 20 (23.5%) 65 (76.5%)
Number of approach
 One 21 (25.9%) 60 (74.1%) 0.730
 Two or more 41 (24.4%) 127 (75.6%)
Comparison of Biopsy Tissue Culture and Blood Culture (<italic>p</italic>-Value = 0.629)
Biopsy Culture Sum
Positive Negative
Blood culture
 Positive 5 21 26 (13.2%)
 Negative 45 126 171 (86.8%)
Sum 50 (25.4%) 147 (74.6%) 197