What is the accuracy of MRI for septic arthritis (SA) imaging?

Answer

A clinically consistent history and the extra-articular findings of bone marrow edema or soft tissue inflammation are important in increasing the specificity of MRI for septic arthritis.

The sensitivity and specificity of MRI is increased in the setting of associated osteomyelitis. MRI is as sensitive as technetium-99m methylene diphosphonate (MDP) scintigraphy in detecting osteomyelitis, and it is more sensitive than other scintigraphic techniques. It is excellent for the evaluation of soft tissues because of its high spatial resolution and multiplanar capability^[47]

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Media Gallery

A 30-year-old man who was taking steroids presented with a joint effusion and knee pain. Anteroposterior view of the knee demonstrates patchy demineralization of the tibia and femur and joint-space narrowing. This was caused by tuberculoid infection of the joint.
Coronal short-tau inversion recovery MRI of the pubic symphysis demonstrates a hyperintense joint effusion and increased signal intensity in the bone marrow of the pubic rami. Abnormal high signal intensity is also present in the bilateral hip adductor muscles. The diagnosis was septic arthritis with associated osteomyelitis and inflammatory changes in the soft tissues.
Septic arthritis. Anteroposterior view of the shoulder demonstrates subchondral erosions and sclerosis in the humeral head. These are relatively late findings of septic arthritis. Periosteal reaction due to coincident osteomyelitis is present adjacent to the surgical neck of the humerus.
Coronal T2-weighted fat-saturated MRI of the shoulder demonstrates a joint effusion, bone marrow edema, and marked adjacent soft tissue inflammation with a fluid collection in the infraspinatus muscle. This is an example of septic arthritis with associated soft tissue abscess.
During the progression of infectious arthritis of the hip, this image was obtained early in the disease and shows only concentric joint-space loss.
During the progression of infectious arthritis of the hip, subchondral erosions and sclerosis of the femoral head are present.
During the progression of infectious arthritis of the hip, subchondral erosions and sclerosis of the femoral head are present.

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Author

Lourdes Nunez-Atahualpa, MD Post-Graduate Fellow in Interventional Radiology, Center for Diagnostic and Endoluminal Therapeutics (CDyTE), Spain; Research Associate, Institute of Research in Rheumatology and Musculoskeletal Disease (IIRSME), Mexico

Disclosure: Nothing to disclose.

Coauthor(s)

Eduardo J Matta, MD, CMQ Assistant Professor of Radiology, Department of Diagnostic and Interventional Imaging, Division of Body Imaging: MR, CT, US, and Flurooscopy, Chief of Body Imaging and Ultrasound, Assistant Professor of Oncology, Department of Internal Medicine, University of Texas Medical School at Houston; Staff Radiologist, Memorial Hermann Hospital and Lyndon B Johnson General Hospital

Eduardo J Matta, MD, CMQ is a member of the following medical societies: American College of Radiology, American Roentgen Ray Society, Radiological Society of North America, Texas Radiological Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Bernard D Coombs, MB, ChB, PhD Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand

Disclosure: Nothing to disclose.

William R Reinus, MD, MBA, FACR Professor of Radiology, Temple University School of Medicine; Chief of Musculoskeletal and Trauma Radiology, Vice Chair, Department of Radiology, Temple University Hospital

William R Reinus, MD, MBA, FACR is a member of the following medical societies: Alpha Omega Alpha, Sigma Xi, American College of Radiology, American Roentgen Ray Society, Radiological Society of North America

Disclosure: Nothing to disclose.

Chief Editor

Felix S Chew, MD, MBA, MEd Professor, Department of Radiology, Vice Chairman for Academic Innovation, Section Head of Musculoskeletal Radiology, University of Washington School of Medicine

Felix S Chew, MD, MBA, MEd is a member of the following medical societies: American Roentgen Ray Society, Association of University Radiologists, Radiological Society of North America

Disclosure: Nothing to disclose.

Additional Contributors

Giuseppe Guglielmi, MD Associate Professor of Radiology, Department of Radiology, Scientific Institute Hospital

Disclosure: Nothing to disclose.

Larry R Holder, MD Residency Director, Consulting Radiologist, Department of Radiology, John H Walker Center for Diagnostic Imaging, Virginia Mason Medical Center

Disclosure: Nothing to disclose.

Acknowledgements

Matthew Studley, MD, MPH, is gratefully acknowledged for contributions made to this topic.

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