Skeletal Radiology

, Volume 28, Issue 11, pp 616–620

The septic versus nonseptic inflamed joint: MRI characteristics

  • Moshe Graif
  • M. E. Schweitzer
  • Diane Deely
  • Theresa Matteucci
Article

DOI: 10.1007/s002560050562

Cite this article as:
Graif, M., Schweitzer, M., Deely, D. et al. Skeletal Radiol (1999) 28: 616. doi:10.1007/s002560050562

Abstract 

Objective. To differentiate the MR features of septic versus nonseptic inflamed joints.

Design and patients. Thirty patients were referred for MRI with inflamed joints (19 were subsequently found to be septic and 11 nonseptic). At 1.5 T enhanced MRI five groups of signs related to joint space, synovium, cartilage, bone and peri-articular soft tissue respectively were assessed and compared between the septic and nonseptic groups.

Results. The prevalence of MRI findings in septic versus nonseptic joints (respectively) was as follows: effusion (79% vs 82%), fluid outpouching (79% vs 73%), fluid heterogeneity (21% vs 27%), synovial thickening (68% vs 55%), synovial periedema (63% vs 55%), synovial enhancement (94% vs 88%), cartilage loss (53% vs 30%), bone erosions (79% vs 38%), bone erosions enhancement (77% vs 43%), bone marrow edema (74% vs 38%), bone marrow enhancement (67% vs 50%), soft tissue edema (63% vs 78%), soft tissue enhancement (67% vs 71%), periosteal edema (11% vs. 10%). The presence of bone erosions appeared to be an indicator for an infected joint (P=0.072); coexistence of bone marrow edema slightly improves the significance (0.068). A similar trend was obtained when combining bone erosions with either synovial thickening, synovial periedema, bone marrow enhancement or soft tissue edema (P=0.075).

Conclusions. The combination of bone erosions with marrow edema is highly suggestive for a septic articulation; the additional coexistence of synovial thickening, synovial edema, soft tissue edema or bone marrow enhancement increases the above level of confidence. Similar to conventional radiography, the single sign that appeared to show a significant trend was the presence of bone erosions. However, no single sign or combination could either be considered pathognomonic or exclude the presence of a joint infection.

Key words Joint MRI Infectious arthritis Septic joint Inflammation 

Copyright information

© International Skeletal Society 1999

Authors and Affiliations

  • Moshe Graif
    • 1
  • M. E. Schweitzer
    • 2
  • Diane Deely
    • 2
  • Theresa Matteucci
    • 2
  1. 1.Tel Aviv Ichilov – Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, IsraelIL
  2. 2.Department of Radiology, Thomas Jefferson University Hospital, 111 S. 11th Street, 3390 Gibbon, Philadelphia, PA 19107, USAUS

Personalised recommendations