Skip to main content

Advertisement

SpringerLink
Log in

MRI findings of treated bacterial septic arthritis

  • Scientific Article
  • Published:
Skeletal Radiology Aims and scope Submit manuscript

Abstract

Introduction

The purpose of this study was to report the MRI findings that can be encountered in successfully treated bacterial septic arthritis.

Materials and methods

The study included 12 patients (8 male and 4 female; mean age 38 years, range 9–85) with 13 proven cases of bacterial septic arthritis. The joints involved were hip (n = 3), knee (n = 3), shoulder (n = 2), sacroiliac (n = 2), ankle (n = 1), wrist (n = 1), and elbow (n = 1). MRI examinations following surgical debridement and at initiation of antibiotic therapy and after successful treatment were compared for changes in effusion, synovium, bone, and periarticular soft tissues. Imaging findings were correlated with microbiological and clinical findings.

Results

Joint effusions were present in all joints at baseline and regressed significantly at follow-up MRI (p = 0.001). Abscesses were present in 5 cases (38 %), and their sizes decreased significantly at follow-up (p = 0.001). Synovial enhancement and thickening were observed in all joints at both baseline and follow-up MRI. Myositis/cellulitis was present in 10 cases (77 %) at baseline and in 8 cases (62 %) at follow-up MRI. Bone marrow edema was present in 10 joints (77 %) at baseline and persisted in 8 joints (62 %). Bone erosions were found in 8 joints (62 %) and persisted at follow-up MRI in all cases.

Conclusion

The sizes of joint effusions and abscesses appear to be the factors with the most potential for monitoring therapy for septic arthritis, since both decreased significantly following successful treatment. Synovial thickening and enhancement, periarticular myositis/cellulitis, and bone marrow edema can persist even after resolution of the infection.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Mathews CJ, Weston VC, Jones A, Field M, Coakley G. Bacterial septic arthritis in adults. Lancet. 2010;375:846–55.

    Article  PubMed  Google Scholar 

  2. Eberst-Ledoux J, Tournadre A, Mathieu S, Mrozek N, Soubrier M, Dubost J-J. Septic arthritis with negative bacteriological findings in adult native joints: a retrospective study of 74 cases. Joint Bone Spine. 2012;79(2):156–9

    Article  PubMed  Google Scholar 

  3. Canvin JM, Goutcher SC, Hagig M, Gemmell CG, Sturrock RD. Persistence of Staphylococcus aureus as detected by polymerase chain reaction in the synovial fluid of a patient with septic arthritis. Br J Rheumatol. 1997;36:203–6.

    Article  PubMed  CAS  Google Scholar 

  4. Hong SH, Kim SM, Ahn JM, Chung HW, Shin MJ, Kang HS. Tuberculous versus pyogenic arthritis: MR imaging evaluation. Radiology. 2001;218:848–53.

    PubMed  CAS  Google Scholar 

  5. Karchevsky M, Schweitzer ME, Morrison WB, Parellada JA. MRI findings of septic arthritis and associated osteomyelitis in adults. AJR Am J Roentgenol. 2004;182:119–22.

    PubMed  Google Scholar 

  6. Bancroft LW. MR imaging of infectious processes of the knee. Radiol Clin N Am. 2007;45:931–41.

    Article  PubMed  Google Scholar 

  7. Lefevre S, Ruimy D, Jehl F, Neuville A, Robert P, Sordet C, et al. Septic arthritis: monitoring with USPIO-enhanced macrophage MR imaging. Radiology. 2011;258:722–8.

    Article  PubMed  Google Scholar 

  8. Erdman WA, Tamburro F, Jayson HT, Weatherall PT, Ferry KB, Peshock RM. Osteomyelitis: characteristics and pitfalls of diagnosis with MR imaging. Radiology. 1991;180:533–9.

    PubMed  CAS  Google Scholar 

  9. Østergaard M, Edmonds J, McQueen F, Peterfy C, Lassere M, Ejbjerg B, et al. An introduction to the EULAR-OMERACT rheumatoid arthritis MRI reference image atlas. Ann Rheum Dis. 2005;64 Suppl 1:3–7.

    Article  Google Scholar 

  10. Johnson PW, Collins MS, Wenger DE. Diagnostic utility of T1-weighted MRI characteristics in evaluation of osteomyelitis of the foot. AJR Am J Roentgenol. 2009;192:96–100.

    Article  PubMed  Google Scholar 

  11. Loeuille D, Sauliere N, Champigneulle J, Rat AC, Blum A, Chary-Valckenaere I. Comparing non-enhanced and enhanced sequences in the assessment of effusion and synovitis in knee OA: associations with clinical, macroscopic and microscopic features. Osteoarthritis Cartilage. 2011;19:1433–9.

    Article  PubMed  CAS  Google Scholar 

  12. König H, Sieper J, Wolf KJ. Rheumatoid arthritis: evaluation of hypervascular and fibrous pannus with dynamic MR imaging enhanced with Gd-DTPA. Radiology. 1990;176:473–7.

    PubMed  Google Scholar 

  13. Ghanem E, Azzam K, Seeley M, Joshi A, Parvizi J. Staged revision for knee arthroplasty infection: what is the role of serological tests before reimplantation? Clin Orthop Relat Res. 2009;467:1699–705.

    Article  PubMed  Google Scholar 

  14. Pääkkönen M, Kallio MJT, Kallio PE, Peltola H. Sensitivity of erythrocyte sedimentation rate and C-reactive protein in childhood bone and joint infections. Clin Orthop Relat Res. 2010;468:861–6.

    Article  PubMed  Google Scholar 

  15. Kusuma SK, Ward J, Jacofsky M, Sporer SM, Della Valle CJ. What is the role of serological testing between stages of two-stage reconstruction of the infected prosthetic knee? Clin Orthop Relat Res. 2011;469:1002–8.

    Article  PubMed  Google Scholar 

  16. Kim H, Kim J, Ihm C. The usefulness of multiplex PCR for the identification of bacteria in joint infection. J Clin Lab Anal. 2010;24:175–81.

    Article  PubMed  CAS  Google Scholar 

  17. Ross JS, Delamarter R, Hueftle MG, Masaryk TJ, Aikawa M, Carter J, et al. Gadolinium-DTPA-enhanced MR imaging of the postoperative lumbar spine: time course and mechanism of enhancement. AJR Am J Roentgenol. 1989;152:825–34.

    PubMed  CAS  Google Scholar 

  18. MacAdam AJ, Sharpe AH. Infectious diseases. In: Kumur V, Abbas AK, Fausto N, Aster J, editors. Robbins and Cotran pathologic basis of disease. 8th ed. Philadelphia: Saunders; 2010. p. 1246–79.

    Google Scholar 

  19. Adzamli IK, Jolesz FA, Bleier AR, Mulkern RV, Sandor T. The effect of gadolinium DTPA on tissue water compartments in slow- and fast-twitch rabbit muscles. Magn Reson Med. 1989;11:172–81.

    Article  PubMed  CAS  Google Scholar 

  20. Boks SS, Vroegindeweij D, Koes BW, Bernsen RMD, Hunink MGM, Bierma-Zeinstra SMA. MRI follow-up of posttraumatic bone bruises of the knee in general practice. AJR Am J Roentgenol. 2007;189:556–62.

    Article  PubMed  Google Scholar 

  21. Finzel S, Rech J, Schmidt S, Engelke K, Englbrecht M, Stach C, et al. Repair of bone erosions in rheumatoid arthritis treated with tumour necrosis factor inhibitors is based on bone apposition at the base of the erosion. Ann Rheum Dis. 2011;70:1587–93.

    Article  PubMed  CAS  Google Scholar 

  22. Døhn UM, Ejbjerg B, Boonen A, Hetland ML, Hansen MS, Knudsen LS, et al. No overall progression and occasional repair of erosions despite persistent inflammation in adalimumab-treated rheumatoid arthritis patients: results from a longitudinal comparative MRI, ultrasonography, CT and radiography study. Ann Rheum Dis. 2011;70:252–8.

    Article  PubMed  Google Scholar 

  23. Kowalski TJ, Layton KF, Berbari EF, Steckelberg JM, Huddleston PM, Wald JT, et al. Follow-up MR imaging in patients with pyogenic spine infections: lack of correlation with clinical features. AJNR Am J Neuroradiol. 2007;28:693–9.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Yawkey 6E, 55 Fruit Street, Boston, MA, 02114, USA

    Guillaume Bierry, Ambrose J. Huang, Connie Y. Chang, Martin Torriani & Miriam A. Bredella

Authors
  1. Guillaume Bierry
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ambrose J. Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Connie Y. Chang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Martin Torriani
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Miriam A. Bredella
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Miriam A. Bredella.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bierry, G., Huang, A.J., Chang, C.Y. et al. MRI findings of treated bacterial septic arthritis. Skeletal Radiol 41, 1509–1516 (2012). https://doi.org/10.1007/s00256-012-1397-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00256-012-1397-2

Keywords

Search

Navigation