CT AND MRI FINDINGS AMONG PATIENTS WITH COCCIDIOIDAL VERTEBRAL OSTEOMYELITIS VERSUS PYOGENIC (BACTERIAL) VERTEBRAL OSTEOMYELITIS

Aim Vertebral osteomyelitis is a severe complication of disseminated coccidioidomycosis. Coccidioidal vertebral osteomyelitis (CVO) and pyogenic(bacterial) vertebral osteomyelitis (PVO) can present similarly; given the difference in treatment, accurate diagnosis is key. We compared CT and MRI imaging findings between patients with CVO and PVO to determine if any difference exists. Method A multicenter hospital system located in the Southwestern United States was queried for patients diagnosed with disseminated coccidioidomycosis between 2013 and 2022, resulting in 370 records. These charts were manually assessed, and 42 patients were found to have vertebral dissemination (CVO). A similar query was performed in the same medical system for patients diagnosed for PVO, which resulted in 7977 patients. Eighty cases were then obtained, to give a final 2:1 ratio between PVO and CVO cases (matching done based on year of diagnosis and race). Each patient's imaging reports, CT and MRI, were then evaluated for the presence of specific radiological findings shown to be indicative of vertebral osteomyelitis. Results In our PVO cohort, 50 received CT scans and 68 received MRIs. For patients with CVO, 31 received CT scans and 34 received MRIs. Based on findings from either method of imaging, abscess was more common among CVO patients (81% vs 53%, p=0.003), as was bone destruction (83% vs. 65%, p=0.036); however, discitis was more commonly found in PVO patients (58% vs 39% p=0.046). Conclusion Imaging presents a potential data point for clinicians attempting to determine the etiology of a patient's vertebral osteomyelitis. Spinal CT with contrast showed efficacy in the detection of abscess and bone destruction and is a reasonable imaging study compared to MRI for resource-limited settings in Coccidioides endemic regions.