ABSTRACT
Background Context
Native vertebral osteomyelitis (NVO) is a severe infection with an increasing incidence
globally. Although there is no widely agreed upon reference standard for diagnosis
of the disease, imaging plays a crucial role. Magnetic resonance imaging (MRI) is
currently the imaging modality of choice. In recent years, advances in imaging have
allowed for a larger role for alternative imaging techniques in the setting of NVO.
Purpose
Our aim was to evaluate the diagnostic accuracy of MRI, PET/CT, and nuclear imaging,
namely 67Gallium and 99mTechnetium scintigraphy, in the diagnosis of pyogenic NVO.
Study Design/Setting
We conducted a systematic review of five medical databases and included all studies
from 1970 to September 2021 that compared imaging techniques and provided sufficient
data for diagnostic test accuracy meta-analysis.
Methods
Abstract screening, full text review, and data extraction were done by a pair of independent
reviewers. Nonnative and nonpyogenic patients were excluded. A bivariate random effect
model was used for meta-analysis.
Results
Twenty studies were included in the meta-analysis, encompassing a total of 1,123 imaging
studies. The meta-analysis sensitivity and specificity of MRI were 90% and 72% respectively;
those of PET/CT were 93% and 80%; those of 67Ga were 95% and 88%; those of 99mTc were 86% and 39%; and the sensitivity and specificity of combined Ga and Tc were
91% and 92% respectively in the setting of suspected NVO.
Conclusions
67Ga has the highest sensitivity for NVO, and its specificity is augmented when combined
with 99mTc. MRI and PET/CT are both highly sensitive modalities, although the specificity
of PET/CT is slightly better. MRI remains an appropriate initial test depending on
the availability of other modalities.
Keywords
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Article info
Publication history
Published online: February 06, 2023
Accepted:
January 26,
2023
Received in revised form:
January 11,
2023
Received:
September 5,
2022
Footnotes
FDA device/drug status: Not applicable.
Author disclosures: JM: Nothing to disclose. SLG: Nothing to disclose. MP: Nothing to disclose. EAKV: Nothing to disclose. AN: Premia Spine, (G); 3 Spine, (D); and AO Spine NA, (E). CC: Nothing to disclose. FED: Nothing to disclose. AJT: Nothing to disclose. MHM: Nothing to disclose. EFB: Nothing to disclose.
Identification
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© 2023 Elsevier Inc. All rights reserved.
