Multilevel or multifocal spine infection may be observed in specific patient groups, such as IV drug users, postoperative spine patients, or in geographic regions with endemic infections such as tuberculosis, coccidioidomycosis, or neurocysticercosis [5,20-22]. The type of infection, whether pyogenic, granulomatous, parasitic, or viral, will likewise influence the clinical and imaging presentation [2,4,5,7,23-26]. Imaging is important for suggesting the diagnosis of spine infection, guiding percutaneous spine biopsy procedures, defining the full extent of infection for the purposes of determining medical and/or surgical management, and for possible clinical follow-up [27-31]. Diagnostic imaging can be used to assess suspected spinal cord compression as well as to evaluate for potential spinal instability, either of which, if present will influence surgical intervention [8,32]. Several diagnostic imaging examinations have been previously utilized in the evaluation and management of spine infection and include radiography, CT, nuclear scintigraphy with various radionuclides, and MRI [20,31,33-37]. Recently, PET/CT has seen increasing application in the evaluation of suspected spine infection, particularly in the postoperative spine [38-45]. PET/MRI is undergoing preliminary investigation for possible use in spine infection [46]. The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through representation of such organizations on expert panels. Participation on the expert panel does not necessarily imply endorsement of the final document by individual contributors or their respective organization. Reprint requests to: publications@acr.org Suspected Spine Infection Although imaging studies have a role in the diagnostic evaluation of suspected spine infection, a high index of clinical suspicion for an infectious etiology is required in order to initiate the clinical workup [47].
Suspected Spine Infection PCAs. Multilevel or multifocal spine infection may be observed in specific patient groups, such as IV drug users, postoperative spine patients, or in geographic regions with endemic infections such as tuberculosis, coccidioidomycosis, or neurocysticercosis [5,20-22]. The type of infection, whether pyogenic, granulomatous, parasitic, or viral, will likewise influence the clinical and imaging presentation [2,4,5,7,23-26]. Imaging is important for suggesting the diagnosis of spine infection, guiding percutaneous spine biopsy procedures, defining the full extent of infection for the purposes of determining medical and/or surgical management, and for possible clinical follow-up [27-31]. Diagnostic imaging can be used to assess suspected spinal cord compression as well as to evaluate for potential spinal instability, either of which, if present will influence surgical intervention [8,32]. Several diagnostic imaging examinations have been previously utilized in the evaluation and management of spine infection and include radiography, CT, nuclear scintigraphy with various radionuclides, and MRI [20,31,33-37]. Recently, PET/CT has seen increasing application in the evaluation of suspected spine infection, particularly in the postoperative spine [38-45]. PET/MRI is undergoing preliminary investigation for possible use in spine infection [46]. The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through representation of such organizations on expert panels. Participation on the expert panel does not necessarily imply endorsement of the final document by individual contributors or their respective organization. Reprint requests to: publications@acr.org Suspected Spine Infection Although imaging studies have a role in the diagnostic evaluation of suspected spine infection, a high index of clinical suspicion for an infectious etiology is required in order to initiate the clinical workup [47].