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Association Between Follow-Up Magnetic Resonance Imaging and Clinical Status Among Patients With Spinal Infections

Baxi, Sanjiv MD, MS*; Malani, Preeti N. MD, MSJ†‡§∥; Gomez-Hassan, Diana MD, PhD; Cinti, Sandro K. MD‡∥

Infectious Diseases in Clinical Practice: September 2012 - Volume 20 - Issue 5 - p 326–329
doi: 10.1097/IPC.0b013e3182639f6a
Original Articles

Background Spinal infections, including paraspinal and/or epidural abscesses and vertebral discitis and osteomyelitis, can have devastating consequences. The diagnostic imaging modality of choice has traditionally been magnetic resonance imaging (MRI) given the very high sensitivity and specificity, although the role of MRI in follow-up of spinal infections and how this relates to follow-up clinical status is poorly understood. We sought to understand the relationship between follow-up MRI and clinical status.

Methods We conducted a retrospective review of adults with spinal infection to assess the relationship between follow-up MRI and clinical course. The degree of agreement between MRI and clinical follow-up was assessed using the Cohen kappa coefficient. A multinomial logistic regression model was applied to assess the impact of covariates in affecting the clinical outcome and MRI at follow-up independently.

Results Ninety-eight patients met inclusion criteria during a 13-year period. We observed a lack of correlation between clinical follow-up status and MRI (κ = 0.065, P = 0.322). The McNemar-Bowker test for symmetry revealed that this disagreement was asymmetric (P < 0.001). Notably, clinical worsening was never associated with an improved MRI, and clinical improvement was overall not predictive of MRI result and vice versa.

Conclusions Routine follow-up MRI does not seem to correlate with clinical follow-up among patients with spinal infections. The use of MRI without new clinical indications in routine follow-up testing should be interpreted with caution.

From the *Department of Internal Medicine, University of California San Francisco, San Francisco, CA; †Divisions of Geriatric Medicine and ‡Infectious Diseases, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI; §Geriatric Research, Education, and Clinical Center (GRECC); ∥Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI and ¶Division of Neuroradiology, Department of Radiology, University of Michigan Health System, Ann Arbor, MI.

Correspondence to: Sandro K. Cinti, MD, Veterans Affairs Ann Arbor Healthcare System, 2215 Fuller Rd, 111-I, Ann Arbor, MI 48105. E-mail:

This work was supported by the University of Michigan Multidisciplinary Clinical Researchers in Training (MCRiT) program (grant number UL1RR024986).

The authors have no conflicts of interest to disclose.

© 2012 Lippincott Williams & Wilkins, Inc.