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MRI Findings of Septic Arthritis and Associated Osteomyelitis in Adults

Michael Karchevsky1, Mark E. Schweitzer2, William B. Morrison1 and J. Antoni Parellada1

1 Department of Radiology, Thomas Jefferson University Hospital, 111 S 11th St., Ste. 3390, Philadelphia, PA 19107.
2 Department of Radiology, Hospital for Joint Diseases, Bernard Aronson Plaza, 301 E 17th St., New York, NY 10003.



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  		Fig. 1A. —35-year-old man with septic arthritis of knee. T1-weighted image shows enhanced thickened synovium (arrows) in suprapatellar bursa.

 


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  		Fig. 1B. —35-year-old man with septic arthritis of knee. On fat-suppressed T1-weighted image (TR/TE, 500/12), this synovium enhances after contrast administration (arrowheads); additionally, subcortical edema (arrow) is present in bare area of tibia.

 


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  		Fig. 1C. —35-year-old man with septic arthritis of knee. Perisynovial edema (arrows) is seen on fat-suppressed T1-weighted image (500/12).

 


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  		Fig. 2A. —52-year-old man with septic first metatarsophalangeal joint. Axial T2-weighted image shows no noticeable joint effusion (asterisk). Note enhancing edema in metatarsal head (arrows) that was shown on biopsy to be osteomyelitis.

 


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  		Fig. 2B. —52-year-old man with septic first metatarsophalangeal joint. Contrast-enhanced T1-weighted image shows synovial enhancement (arrowheads) and marrow enhancement.

 


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  		Fig. 3A. —50-year-old woman with septic arthritis of left sacroiliac joint and negative findings for osteomyelitis on biopsy. On axial T2-weighted fat-suppressed image, reactive marrow edema in sacrum (asterisk) is greater than edema in ilium, consistent with reactive changes. Also noted is effusion posteriorly, anteriorly, and medially (curved arrows). What is striking is synovial outpouching (thick straight arrow), and its dissection away from joint (thin straight arrows) to form microabscess.

 


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  		Fig. 3B. —50-year-old woman with septic arthritis of left sacroiliac joint and negative findings for osteomyelitis on biopsy. Reactive edema enhances after IV administration of contrast material (arrow) on T1-weighted image. Note rim enhancement of fluid outpouching (arrowheads).

 

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