The aims of this study were (i) to assess the diagnostic performance of computed tomography (CT)-guided percutaneous needle bone biopsy (CTNBB) in patients with suspected osteomyelitis and discitis and (ii) to analyze if certain clinical or technical factors were associated with positive microbiology results.

All CTNBB procedures performed for suspected osteomyelitis and spondylodiscitis between 2003-2018 were reviewed. Detailed information was collected on associated technical and clinical data. Biopsy results including surgical histopathology and microbiology culture, and/or clinical and imaging follow-up were defined as the standard of reference.Analyses were subdivided by skeletal site (AS and AXS) and whether subjects were on antimicrobial therapy. Pearson’s X squared test was used to assess whether biopsy results varied by site or antimicrobial therapy. Logistic regression was performedto assess associations between needle size, comorbidities,...

A total of 142 CTNBB were performed (46.5% female; age [±SD] 46.10 [±22.8years]), 72 (50.7%) from the appendicular skeleton and 70 (49.3%) from the axial skeleton (Table 1). Staphylococcus aureus and epidermidis were the most common pathogens isolated in the AS and AXS cultures (Figure 1).CTNBB showed a sensitivity of 42.5% [95% CI32.0%-53.6%], in isolating the causative pathogen. We found a higher rate of positive microbiology results in patients with intravenous drug use (odds ratio (OR)=5.15; 95% CI 1.2-21.0 p=0.022) (Figure 2) and elevated WBC...

CTNBB when positive is a useful minimally invasive technique for the definitive diagnosis of osteomyelitis and discitis. Nevertheless, this procedure was found to have a low sensitivity of only 42.5% for isolating the causative pathogen. Interestingly, the rate of positive microbiology samples was significantly higher in subjects with intravenous drug use, elevated WBC values and fever.These findings could potentially improve the microbiology yield by optimizing the timing of the CTNBB.

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S. Schirò, M.D. University of California San Francisco, Department of Radiology and Biomedical Imaging, San Francisco CA; Università degli Studi di Parma, Dipartimento di Scienze Radiologiche, Parma Italy