Prediktivna vrijednost inicijalnoga pregleda kralježnice magnetskom rezonancijom za klinički ishod liječenja vertebralnoga osteomijelitisa

doctoral thesis

• Title (english): The predictive value of initial spinal MRI findings for post-therapeutic clinical outcome of vertebral osteomyelitis
• Author: Matej Mustapić
• Mentor: Klaudija Višković (mentor)
• Committee member: nije dostupno (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; Zagreb
• Defense date and country: 2014-10-10, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences
• Universal decimal classification (UDC): 61 - Medical sciences

Abstract

Cilj istraživanja: Analizirati početne kliničke, laboratorijske i nalaze inicijalnog pregleda kralježnice magnetskom rezonancijom (MR) u bolesnika s vertebralnim osteomijelitisom, te odrediti njihovu povezanost s konačnim ishodom bolesti. ----- Ispitanici i metode: Retrospektivno istraživanje 110 bolesnika s potvrđenim piogenim vertebralnim osteomijelitisom koji su bili hospitalizirani u razdoblju od 5 godina i to od 2006. do 2010. godine. Svim ispitanicima su učinjene kliničke i laboratorijske pretrage te inicijalno i MR pregled kralježnice prema istom protokolu. Ispitanici su podijeljeni u dvije skupine ovisno o nalazima MR pregleda i to: ispitanici s ranim i ispitanici s uznapredovalim promjenama. Kao ishodi bolesti razmatrani su: potpuni klinički oporavak, rezidualni neurološki deficit ili bol i smrt, te je analiziran njihov odnos s kliničkim i slikovnim nalazima. ----- Rezultati: Nije bilo statistički značajne razlike u početnim kliničkim osobitostima ispitanika, broju zahvaćenih kralježaka i anatomskom položaju, između dvije skupine ispitanika. Viši stupanj komorbiditeta i produženo liječenje antibioticima bili su povezani s uznapredovalim promjenama na MR pregledu kralježnice (p=0.006, odnosno p=0.004). Ispitanici koji su pokazivali uznapredovale promjene na MR pregledu kralježnice češće su bili kirurški liječeni (p=0.007). Nije pronađena statistički značajna razlika u ishodu bolesti između ispitanika s ranim i ispitanika s uznapredovalim MR promjenama kralježnice (p=0.563). ----- Zaključak: Premda su ispitanici s uznapredovalim promjenama na MR pregledu kralježnice češće trebali produženu antibiotsku terapiju i kirurško liječenje, nalaz inicijalnog MR pregleda kralježnice u bolesnika s piogenim vertebralnim osteomijelitisom nije pokazao prognostičku vrijednost za ishod bolesti. Uznapredovale promjene na MR pregledu kralježnice češće se vide u ispitanika s višim stupnjem komorbiditeta, što je vjerojatno uvjetovano oslabljenim imunološkim odgovorom bilo zbog primjerice šećerne bolesti ili kroničnog bubrežnog zatajenja, ili zbog djelomične promjene imunološkog odgovora lijekovima u bolesnika s upalnim reumatskim bolestima, što također umanjuje i osjet boli.

Abstract (english)

Aim: To analyze the initial clinical, laboratory and magnetic resonance imaging (MRI) findings in patients with vertebral osteomyelitis and to determine their correlation with the disease outcome. ----- Patients and methods: A retrospective study of 110 patients with confirmed pygenic vertebral osteomyelitis treated in a 5-year period, between 2006 and 2010. Patients included in the study initially had clinical and biological examinations and MRI of spine according to the same protocol. MRI findings were divided in moderate and advanced changes. Complete clinical recovery, residual neurological deficits or pain and death were observed as the disease outcome and put in correlation with clinical and imaging findings. ----- Results: There was no significant difference in clinical presentation at admission, number of affected vertebral bodies nor anatomic location between a group of patients with moderate and patients with advanced MRI changes. High Charlson comorbity index (CCI) score and longer treatment with antibiotics were associated with advanced MRI changes (p=0.006 and p=0.004, respectively). Patients with advanced MRI changes more frequently underwent surgical intervention than patients with moderate MRI changes of vertebral osteomyelitis (p=0.007). There was no difference between patients with moderate and patients with advanced MRI changes regarding the disease outcome (p=0.563). ----- Conclusion: Although the patients with advanced MRI changes are more likely to need prolonged antibiotic therapy and surgical intervention, the findings of initially performed MRI in patients with pyogenic vertebral osteomyelitis have no prognostic value regarding the disease outcome. The advanced MRI changes in patients with vertebral osteomyelitis are more often observed in patients with high CCI score, probably due to impaired immune response caused by diabetes or chronic renal failure or because of partial modulation of the immune response with medications in patients with inflammatory rheumatic diseases.

• Keywords: medicina
• Keywords (english): medicine
• Language: croatian
• URN:NBN: urn:nbn:hr:105:448011
• Study programme: Title: Biomedicine and Health Sciences; Study programme type: university; Study level: postgraduate; Academic / professional title: doktor/doktorica znanosti, područje biomedicine i zdravstva (doktor/doktorica znanosti, područje biomedicine i zdravstva)
• Type of resource: Text
• Extent: 101 str.
• File origin: Born digital
• Access conditions: Open access
• Created on: 2023-05-05 07:24:39