MR imaging of septic sacroiliitis
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Objective. To investigate the diagnostic value of magnetic resonance (MR) imaging in detecting septic sacroiliitis and to determine whether the MR characteristics allow this entity to be differentiated from sacroiliitis in spondylarthropathy (SpA).
Patients and design. The imaging findings of 11 patients with septic sacroiliitis were retrospectively analyzed by two experienced radiologists. Radiographic surveys of the pelvis as well as computed tomography (CT) and MR images of the sacroiliac joints were available in all cases. Seven of the patients additionally underwent a follow-up MR examination. The MR imaging protocol comprised combinations of coronal and transverse T1-weighted spin-echo (SE) or fast SE sequences, T2-weighted gradient-echo (GE) sequences and short tau inversion recovery sequence (STIR) sequences as well as dynamic contrast- enhanced T1-weighted acquisitions.
Results. Three patients with a short disease history showed anterior and/or posterior subperiosteal infiltrations (”lava cleft phenomenon”), transcapsular infiltrations of juxta-articular muscle layers, which obscured the fasciae, and periarticular bone marrow edema. The eight patients with more advanced stages of sacroiliitis additionally showed abscess formation, sequestration, and erosion. At follow-up MR examination (n=7) under systemic antibiotic treatment, the morphologic characteristics showed progression (n=1), regression (n=4), unchanged findings (n=1), or a mixed response (n=1). Clinical improvement precedes resolution of the MR findings.
Conclusions. Anterior and/or posterior subperiosteal infiltrations and transcapsular infiltrations of juxta-articular muscle layers were depicted in all patients. These MR imaging findings are characteristic of septic sacroiliitis and may be used to differentiate this entity from sacroiliitis in SpA.
- MR imaging of septic sacroiliitis
Volume 29, Issue 8 , pp 439-446
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- Key words Magnetic resonance (MR) imaging
- Sacroiliac joint
- Septic sacroiliitis
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- Author Affiliations
- A1. Humboldt-Universität zu Berlin, Department of Radiology, Charité Medical School, Schumannstrasse 20/21, 10117 Berlin, Germany, DE
- A2. Freie Universität Berlin, Benjamin Franklin Medical School, Department of Nephrology and Rheumatology, Hindenburgdamm 30, 12200 Berlin, Germany, DE
- A3. Unfallkrankenhaus Berlin, Department of Radiology, Brebacher Weg 15, 12683 Berlin, Germany, DE
- A4. Krankenhaus Berlin-Buch, II. Kinderklinik, Wittbergstrasse 50, 13125 Berlin, Germany, DE