Percutaneous CT guided bone biopsy for suspected osteomyelitis: Diagnostic yield and impact on patient's treatment change and recovery

Diana Hoang, Stephen Fisher, Orhan K Oz, Javier La Fontaine, Avneesh Chhabra

Research output: Contribution to journalArticle

Abstract

Aim: To evaluate the utility of percutaneous CT guided bone biopsy (PCBB) for suspected osteomyelitis (OM) and its eventual impact on patient management and recovery. Material and methods: Patients who received a PCBB for suspected osteomyelitis from years 2012-2018. Patient demographics, lesion location, ulcer grade, signs of toxemia, serology, wound and blood cultures, bone biopsy and cross-sectional imaging results were recorded. Diagnostic yield of the bone biopsy and its role in influencing the final treatment plan and patient recovery were evaluated. Chi-square test was used. P-value less than 0.05 was considered statistically significant. Results: 115 patients with mean age 50.86 ± 14.49 years were included. The common locations were sacrum/ischium (49/115, 43%) and spine (35/115, 30%). Clinically, 40/115 (35%) had toxemia and 67/115 (58%) had ulcers. Per serology, 17/111 (15%), 95/106 (90%), and 86/98 (88%) had an elevated WBC, CRP, and sedimentation rate, respectively. 22/91 (24%) had a positive blood culture and all 23/23 had a positive wound culture. On imaging, definitive and possible OM were reported in 84.1% and 14.2%, respectively, with 1.8% as no OM. Only 24/115 (21%) had a positive bone biopsy culture and only 10/24 (42%) total positive bone cultures impacted the treatment plan. There was no significant effect of antibiotics on the diagnostic yield of culture (p = 0.08). No statistical significance was found when comparing treatment change based on bone culture results versus all other factors combined (p = 0.33), or when comparing clinical improvement with and without positive bone cultures (p = 0.12). Conclusion: Despite positive cross-sectional imaging findings of OM, bone biopsy yield of positive culture is low, and it leads to a small impact in changing the treatment plan or altering the course of patient recovery.

Original languageEnglish (US)
Pages (from-to)85-91
Number of pages7
JournalEuropean Journal of Radiology
Volume114
DOIs
StatePublished - May 1 2019

Fingerprint

Osteomyelitis
Biopsy
Bone and Bones
Toxemia
Therapeutics
Serology
Ulcer
Ischium
Sacrum
Wounds and Injuries
Chi-Square Distribution
Spine
Demography
Anti-Bacterial Agents

Keywords

  • Bone biopsy
  • Bone infection
  • CT
  • MRI
  • Osteomyelitis

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

@article{b5988c3a23974180bd757a0f7e53d59a,
title = "Percutaneous CT guided bone biopsy for suspected osteomyelitis: Diagnostic yield and impact on patient's treatment change and recovery",
abstract = "Aim: To evaluate the utility of percutaneous CT guided bone biopsy (PCBB) for suspected osteomyelitis (OM) and its eventual impact on patient management and recovery. Material and methods: Patients who received a PCBB for suspected osteomyelitis from years 2012-2018. Patient demographics, lesion location, ulcer grade, signs of toxemia, serology, wound and blood cultures, bone biopsy and cross-sectional imaging results were recorded. Diagnostic yield of the bone biopsy and its role in influencing the final treatment plan and patient recovery were evaluated. Chi-square test was used. P-value less than 0.05 was considered statistically significant. Results: 115 patients with mean age 50.86 ± 14.49 years were included. The common locations were sacrum/ischium (49/115, 43{\%}) and spine (35/115, 30{\%}). Clinically, 40/115 (35{\%}) had toxemia and 67/115 (58{\%}) had ulcers. Per serology, 17/111 (15{\%}), 95/106 (90{\%}), and 86/98 (88{\%}) had an elevated WBC, CRP, and sedimentation rate, respectively. 22/91 (24{\%}) had a positive blood culture and all 23/23 had a positive wound culture. On imaging, definitive and possible OM were reported in 84.1{\%} and 14.2{\%}, respectively, with 1.8{\%} as no OM. Only 24/115 (21{\%}) had a positive bone biopsy culture and only 10/24 (42{\%}) total positive bone cultures impacted the treatment plan. There was no significant effect of antibiotics on the diagnostic yield of culture (p = 0.08). No statistical significance was found when comparing treatment change based on bone culture results versus all other factors combined (p = 0.33), or when comparing clinical improvement with and without positive bone cultures (p = 0.12). Conclusion: Despite positive cross-sectional imaging findings of OM, bone biopsy yield of positive culture is low, and it leads to a small impact in changing the treatment plan or altering the course of patient recovery.",
keywords = "Bone biopsy, Bone infection, CT, MRI, Osteomyelitis",
author = "Diana Hoang and Stephen Fisher and Oz, {Orhan K} and {La Fontaine}, Javier and Avneesh Chhabra",
year = "2019",
month = "5",
day = "1",
doi = "10.1016/j.ejrad.2019.01.032",
language = "English (US)",
volume = "114",
pages = "85--91",
journal = "European Journal of Radiology",
issn = "0720-048X",
publisher = "Elsevier Ireland Ltd",

}

TY - JOUR

T1 - Percutaneous CT guided bone biopsy for suspected osteomyelitis

T2 - Diagnostic yield and impact on patient's treatment change and recovery

AU - Hoang, Diana

AU - Fisher, Stephen

AU - Oz, Orhan K

AU - La Fontaine, Javier

AU - Chhabra, Avneesh

PY - 2019/5/1

Y1 - 2019/5/1

N2 - Aim: To evaluate the utility of percutaneous CT guided bone biopsy (PCBB) for suspected osteomyelitis (OM) and its eventual impact on patient management and recovery. Material and methods: Patients who received a PCBB for suspected osteomyelitis from years 2012-2018. Patient demographics, lesion location, ulcer grade, signs of toxemia, serology, wound and blood cultures, bone biopsy and cross-sectional imaging results were recorded. Diagnostic yield of the bone biopsy and its role in influencing the final treatment plan and patient recovery were evaluated. Chi-square test was used. P-value less than 0.05 was considered statistically significant. Results: 115 patients with mean age 50.86 ± 14.49 years were included. The common locations were sacrum/ischium (49/115, 43%) and spine (35/115, 30%). Clinically, 40/115 (35%) had toxemia and 67/115 (58%) had ulcers. Per serology, 17/111 (15%), 95/106 (90%), and 86/98 (88%) had an elevated WBC, CRP, and sedimentation rate, respectively. 22/91 (24%) had a positive blood culture and all 23/23 had a positive wound culture. On imaging, definitive and possible OM were reported in 84.1% and 14.2%, respectively, with 1.8% as no OM. Only 24/115 (21%) had a positive bone biopsy culture and only 10/24 (42%) total positive bone cultures impacted the treatment plan. There was no significant effect of antibiotics on the diagnostic yield of culture (p = 0.08). No statistical significance was found when comparing treatment change based on bone culture results versus all other factors combined (p = 0.33), or when comparing clinical improvement with and without positive bone cultures (p = 0.12). Conclusion: Despite positive cross-sectional imaging findings of OM, bone biopsy yield of positive culture is low, and it leads to a small impact in changing the treatment plan or altering the course of patient recovery.

AB - Aim: To evaluate the utility of percutaneous CT guided bone biopsy (PCBB) for suspected osteomyelitis (OM) and its eventual impact on patient management and recovery. Material and methods: Patients who received a PCBB for suspected osteomyelitis from years 2012-2018. Patient demographics, lesion location, ulcer grade, signs of toxemia, serology, wound and blood cultures, bone biopsy and cross-sectional imaging results were recorded. Diagnostic yield of the bone biopsy and its role in influencing the final treatment plan and patient recovery were evaluated. Chi-square test was used. P-value less than 0.05 was considered statistically significant. Results: 115 patients with mean age 50.86 ± 14.49 years were included. The common locations were sacrum/ischium (49/115, 43%) and spine (35/115, 30%). Clinically, 40/115 (35%) had toxemia and 67/115 (58%) had ulcers. Per serology, 17/111 (15%), 95/106 (90%), and 86/98 (88%) had an elevated WBC, CRP, and sedimentation rate, respectively. 22/91 (24%) had a positive blood culture and all 23/23 had a positive wound culture. On imaging, definitive and possible OM were reported in 84.1% and 14.2%, respectively, with 1.8% as no OM. Only 24/115 (21%) had a positive bone biopsy culture and only 10/24 (42%) total positive bone cultures impacted the treatment plan. There was no significant effect of antibiotics on the diagnostic yield of culture (p = 0.08). No statistical significance was found when comparing treatment change based on bone culture results versus all other factors combined (p = 0.33), or when comparing clinical improvement with and without positive bone cultures (p = 0.12). Conclusion: Despite positive cross-sectional imaging findings of OM, bone biopsy yield of positive culture is low, and it leads to a small impact in changing the treatment plan or altering the course of patient recovery.

KW - Bone biopsy

KW - Bone infection

KW - CT

KW - MRI

KW - Osteomyelitis

UR - http://www.scopus.com/inward/record.url?scp=85062594093&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85062594093&partnerID=8YFLogxK

U2 - 10.1016/j.ejrad.2019.01.032

DO - 10.1016/j.ejrad.2019.01.032

M3 - Article

C2 - 31005182

AN - SCOPUS:85062594093

VL - 114

SP - 85

EP - 91

JO - European Journal of Radiology

JF - European Journal of Radiology

SN - 0720-048X

ER -