Other Tests Are “Better,” So Why Stick With MRI for Vertebral Osteomyelitis?

A meta-analysis shows us how to raise our diagnostic game for an uncommon but serious spinal condition — pyogenic native vertebral osteomyelitis

Smart Practice: Although other modalities may appear to have advantages, MRI with contrast remains the go-to approach for patients who may have the kinds of spinal infections you don’t want to miss.

What’s the Claim?

A meta-analysis of 20 studies and more than 1100 diagnostic scans found the following sensitivity and specificity pairings for the diagnosis of pyogenic native vertebral osteomyelitis:

  • MRI with contrast: 90% sensitive and 72% specific
  • PET/CT: 93% and 80%
  • Gallium (Ga-67) scan: 95% and 80%
  • Technetium (Tc-99m) scan: 86% and 39%
  • Combination Ga-67 + Tc-99m: 91% and 92%

All things considered, though, MRI with contrast remains the test of choice. We’ll explain.

How’s It Stack Up?

This was a well-designed and well-reported meta-analysis — as such, it comports with the best-available evidence on the topic. Some of the studies they included about the nuclear medicine tests are older, but two of the three studies they found that evaluated the combination of Ga-67 and Tc-99m were performed within the last 10 years or so. Most of the rest of the recent studies, and the majority of the studies overall, compared MRI (because it’s widely used) to PET/CT (because it’s new and exciting, at least to some).