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Septic arthritis versus transient synovitis at MR imaging: preliminary assessment with signal intensity alterations
1Department of Radiology, Kyungpook National University College of Medicine, Taegu, Korea.
Purpose:
To find any differential magnetic resonance (MR) imaging findings between septic arthritis and transient synovitis in pediatric patients.
Materials And Methods:
The MR imaging findings in nine pediatric patients with septic arthritis and 14 with transient synovitis were retrospectively studied. The diagnoses were made by means of joint aspiration with bacteriologic study, arthrotomy, and clinical evaluation. MR imaging findings were analyzed with emphasis on the grade of joint effusion and alterations in signal intensity in the soft tissue and bone marrow of the affected hip joint.
Results:
Signal intensity alterations in bone marrow (i.e., low signal intensity on fat-suppressed gadolinium-enhanced T1-weighted spin-echo images and high signal intensity on fat-suppressed T2-weighted fast spin-echo images) were seen in eight of nine patients with septic arthritis. These signal intensity alterations consisted of mild juxtaarticular changes in six patients without osteomyelitis and extensive changes in the femoral head and neck in two patients with coexistent osteomyelitis. Signal intensity alterations in bone marrow were not seen in the 14 patients with transient synovitis.
Conclusion:
Signal intensity alterations in the bone marrow of the affected hip joint are useful in the differentiation of septic arthritis from transient synovitis.
Insights
Bone marrow signal intensity changes on MRI can differentiate pediatric septic arthritis from transient synovitis. This finding aids in diagnosing hip joint infections in children.
Area of Science:
- Pediatric Radiology
- Musculoskeletal Imaging
- Infectious Disease Imaging
Background:
- Septic arthritis and transient synovitis are common causes of hip pain in children.
- Accurate differentiation is crucial for appropriate management and preventing long-term complications.
Purpose of the Study:
- To identify differential magnetic resonance (MR) imaging findings distinguishing septic arthritis from transient synovitis in pediatric patients.
- To evaluate the utility of bone marrow signal intensity alterations in differentiating these conditions.
Main Methods:
- Retrospective analysis of MR imaging findings in 23 pediatric patients (9 septic arthritis, 14 transient synovitis).
- Assessment of joint effusion and signal intensity changes in soft tissue and bone marrow of the affected hip.
- Diagnosis confirmation through joint aspiration, bacteriologic study, arthrotomy, and clinical evaluation.
Main Results:
- Bone marrow signal intensity alterations (low T1, high T2 on fat-suppressed images) were observed in 8/9 patients with septic arthritis.
- These alterations indicated juxtaarticular changes or extensive femoral head/neck involvement in cases with coexistent osteomyelitis.
- No bone marrow signal intensity alterations were detected in any of the 14 patients with transient synovitis.
Conclusions:
- Bone marrow signal intensity alterations on MR imaging are a valuable indicator for differentiating pediatric septic arthritis from transient synovitis.
- This imaging finding can aid clinicians in making timely and accurate diagnoses of hip joint pathology in children.