OBJECTIVES To compare imaging and clinical features of fungal and Staphylococcus aureus discitis-osteomyelitis (DO) for patients presenting for CT-guided biopsies. METHODS Our study was IRB-approved and HIPAA-compliant. A group of 11 fungal DO (FG) with MRI within 7 days of the biopsy and a control group (CG) of 19 Staphylococcus aureus DO were evaluated. Imaging findings (focal vs diffuse paravertebral soft tissue abnormality, partial vs complete involvement of the disc/endplate), biopsy location, pathology, duration of back pain, immune status, history of intravenous drug, history of prior infection, current antibiotic treatment, and history of invasive intervention. Differences were assessed using the Fisher exact test and Kruskal-Wallis test. Naïve Bayes predictive modeling was performed. RESULTS The most common fungal organisms were Candida species (9/11, 82%). The FG was more likely to have focal soft tissue abnormality (p = 0.040) and partial disc/endplate involvement (p = 0.053). The clinical predictors for fungal DO, in order of importance, back pain for 10 or more weeks, current antibiotic use for 1 week or more, and current intravenous drug use. History of invasive instrumentation within 1 year was more predictive of Staphylococcus aureus DO. CONCLUSION MRI features (focal partial soft tissue abnormality and partial involvement of the disc/endplate) in combination with clinical features may help to predict fungal species as a causative organism for DO. KEY POINTS • MRI features of discitis-osteomyelitis (focal partial soft tissue abnormality and partial involvement of the disc/endplate) in combination with clinical features may help to predict fungal species as a causative organism for DO.

中文翻译：

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急性真菌性椎间盘炎/骨髓炎的 MRI 和临床特征。

目的 比较接受 CT 引导活检的患者的真菌和金黄色葡萄球菌椎间盘炎-骨髓炎 (DO) 的影像学和临床特征。方法 我们的研究获得 IRB 批准并符合 HIPAA 标准。一组 11 例真菌 DO (FG) 在活检后 7 天内进行了 MRI 评估，对照组 (CG) 的 19 例金黄色葡萄球菌 DO 进行了评估。影像学检查结果（局灶性与弥漫性椎旁软组织异常、椎间盘/终板部分受累与完全受累）、活检位置、病理学、背痛持续时间、免疫状态、静脉用药史、既往感染史、当前抗生素治疗以及侵入性干预史。使用 Fisher 精确检验和 Kruskal-Wallis 检验评估差异。进行了朴素贝叶斯预测建模。结果 最常见的真菌生物体是念珠菌属 (9/11, 82%)。FG 更可能有局灶性软组织异常 (p = 0.040) 和部分椎间盘/终板受累 (p = 0.053)。真菌 DO 的临床预测因子按重要性排序为背痛 10 周或更长时间、目前使用抗生素 1 周或更长时间以及当前静脉注射药物。1 年内的侵入性仪器史更能预测金黄色葡萄球菌 DO。结论 MRI 特征（局灶性部分软组织异常和椎间盘/终板部分受累）结合临床特征可能有助于预测真菌种类作为 DO 的致病微生物。