Abstract
Background/Objectives: Vertebral discitis osteomyelitis (VDO) is a serious infection involving the vertebral bodies and intervertebral discs, often requiring biopsy for pathogen identification. However, biopsy yields are variable, and guidance on patient selection remains limited. This study aimed to assess how biopsy culture results influence clinical management and to develop imaging-based scoring systems to predict biopsy outcomes. Methods: In this retrospective study, 70 patients who underwent image-guided vertebral biopsy for suspected VDO between 2013 and 2022 were reviewed. Pre-biopsy MRI and CT findings were scored using novel, simplified criteria. MRI was graded based on soft tissue involvement, while CT evaluated the presence or absence of a vacuum phenomenon. Culture results were correlated with imaging scores and subsequent changes in antibiotic management. Statistical analysis included logistic regression, ROC analysis, and interobserver agreement using Cohen's Kappa. Results: Of the 70 patients, 27 (38.6%) had positive cultures, and 20 (28.5%) experienced changes in management. Among the 48 patients with both MRI and CT imaging, MRI scores indicating soft tissue involvement and absence of the vacuum sign on CT were independent predictors of positive culture (p = 0.022 and p = 0.047, respectively). The combined predictive model showed an AUC of 0.76. Interobserver agreement was excellent (κ = 0.90 for MRI, κ = 0.95 for CT). Conclusions: MRI and CT features can be used to predict biopsy yield and guide clinical decisions in suspected VDO. These scoring systems may help clinicians identify patients most likely to benefit from biopsy, potentially improving outcomes and minimizing unnecessary procedures.