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MRI features distinguishing pediatric Lyme arthritis from septic arthritis

Joshua E Powell1, Vincent K Lee2,3, Suraj S Parikh4

  • 1Department of Radiology, Division of Musculoskeletal Imaging, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA. powellj713@gmail.com.

Skeletal Radiology
|October 7, 2024
PubMed

Insights

Distinguishing Lyme arthritis (LA) from septic arthritis (SA) in children is crucial. MRI findings like abnormal synovium and joint effusion suggest LA, while bone erosion strongly indicates SA.

Area of Science:

  • Pediatric infectious diseases
  • Medical imaging
  • Rheumatology

Background:

  • Lyme arthritis (LA) is a growing cause of pediatric infectious arthritis in the USA.
  • Rapid differentiation between LA and septic arthritis (SA) is essential for appropriate patient management.
  • Magnetic Resonance Imaging (MRI) plays a key role in diagnosing joint conditions.

Purpose of the Study:

  • To identify distinct MRI features that differentiate pediatric Lyme arthritis (LA) from septic arthritis (SA).
  • To aid in the early and accurate diagnosis of pediatric infectious arthritis.
  • To improve clinical decision-making and treatment strategies for pediatric joint infections.

Main Methods:

  • Retrospective analysis of pediatric patients diagnosed with LA or SA in an endemic area.
  • Review of MRI scans by a pediatric radiologist, focusing on joint effusion, synovitis, myositis, soft tissue edema, and osseous changes.
  • Statistical comparison of MRI features, demographics, and clinical data between LA and SA groups.

Main Results:

  • Larger joint effusions and thickened synovium were more common in Lyme arthritis.
  • Increased myositis, subcutaneous edema, and osseous changes were more prevalent in septic arthritis.
  • Bone marrow signal abnormalities and bone erosion were significantly associated with septic arthritis, with no bone erosion observed in Lyme arthritis cases.

Conclusions:

  • MRI is a valuable tool for differentiating pediatric Lyme arthritis from septic arthritis.
  • Specific MRI findings, such as synovium abnormalities and joint effusion size, can suggest Lyme arthritis.
  • The absence of bone erosion on MRI effectively rules out Lyme arthritis, while its presence strongly favors septic arthritis.
Abstract

Keywords:
ArthritisKneeLymeMRIPediatricSepticSynovitis

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