Have an account? Please log in.
Text size: Small font Default font Larger font
.
Radiology Daily
Radiology Daily PracticalReviews.com Radiology Daily

Differentiating Septic Arthritis From Transient Synovitis through MRI

March 12, 2009
Written by: , Filed in: Musculoskeletal Radiology
  • Comments
.

Acute nontraumatic hip pain in young patients is most commonly caused by septic arthritis or transient synovitis. Clinical presentation is similar, but treatment is different. A synovitis is managed with analgesics, whereas septic arthritis requires drainage and antibiotics.

The objective of a study published in The American Journal of Roentgenology was to identify differences in femoral hip perfusion in patients with acute hip pain and joint effusion.

This study reviewed MRIs of 20 patients, 11 with transient synovitis and nine with septic arthritis. The MRIs were reviewed by two musculoskeletal radiologists in consensus, and were assessed for joint effusions, soft tissue and bone marrow signal alterations, synovial thickening, and decreased femoral hip perfusion.

It was interesting to see that there was decreased perfusion in the femoral head in this study. Avascular necrosis was a known complication of septic arthritis, and the study found femoral photopenia and acetabular photopenia on bone scans in septic arthritis of the hip.

Decreased perfusion was also found in two patients with transient synovitis, which may be explained by the increased intracapsular pressure.

Previous investigators found a correlation between Legg-Calvé-Perthes disease and the incidence and causation of transient synovitis.

MRIs should be performed prior to all thoracenteses in patients with painful hips, as there is likely a relationship between intracapsular pressure, effusion, and impaired perfusion.

Coronal fat-suppressed T1-weighted images of both hips should be performed immediately after contrast administration before arthrocentesis is performed.

MDCT and MR Update: Body and Musculoskeletal Imaging

University of California San Francisco, Department of Radiology and Biomedical Imaging
MDCT and MR Update: Body and Musculoskeletal Imaging program features helical multi-detector row CT (MDCT) and MRI as it applies to diseases in the chest, abdomen and pelvis, and musculoskeletal system. Newer and established cross-sectional methods are discussed. Click here to read more or order:

MDCT and MR Update: Body and Musculoskeletal Imaging

It appears beneficial to assess perfusion of the femoral head for differentiating septic arthritis from transient synovitis. In this study, decreased perfusion of the femoral head was a useful sign in differentiating septic arthritis from transient synovitis, and being able to treat each appropriately.

Reference: Kwack K-S, Cho J-H, et al. Septic Arthritis Versus Transient Synovitis of the Hip: Gadolinium-Enhanced MRI Finding of Decreased Perfusion at the Femoral Epiphysis. AJR 2007; 189 (August): 437–445.

—–

Related CME:
MDCT and MR Update: Body and Musculoskeletal Imaging
University of California San Francisco, Department of Radiology and Biomedical Imaging
MDCT and MR Update: Body and Musculoskeletal Imaging program features helical multi-detector row CT (MDCT) and MRI as it applies to diseases in the chest, abdomen and pelvis, and musculoskeletal system. Newer and established cross-sectional methods are discussed. For MDCT, emphasis is placed on high-resolution chest CT, the diagnosis of pulmonary artery and aortic abnormalities, lung cancer and the solitary nodule, and use of multiplanar reformations (MPRs) for abdomen and pelvis. The use of neutral oral contrast material and proper timing of intravenous contrast agent with fast scanning is emphasized. For MRI, state-of-the-art techniques are addressed. Earn up to 21.25 AMA PRA Category 1 Credits™.
Read more or order: MDCT and MR Update: Body and Musculoskeletal Imaging

Musculoskeletal MRI
University of California San Francisco Department of Radiology and Biomedical Imaging
Musculoskeletal MRI is one of the few musculoskeletal imaging courses designed for both the beginner and the advanced practitioner in musculoskeletal MRI. The basic fundamentals of imaging, as well as the more sophisticated techniques are presented in this musculoskeletal video course. Up-to-date imaging protocols are taught, as well as imaging pitfalls to ensure that you properly identify musculoskeletal injuries. Particular attention is placed on the more commonly requested exams, such as the knee, shoulder, and ankle. Earn up to 12 AMA PRA Category 1 Credits™.
Read more or order: Musculoskeletal MRI

.
  • Comments
.

Would you like to keep current with radiological news and information?

Post Your Comments and Responses

Comments are closed.