MRI features distinguishing pediatric Lyme arthritis from septic arthritis

Joshua E Powell; Vincent K Lee; Suraj S Parikh; Andrew J Nowalk; Amisha J Shah

doi:10.1007/s00256-024-04804-2

MRI features distinguishing pediatric Lyme arthritis from septic arthritis

Skeletal Radiol. 2024 Oct 7. doi: 10.1007/s00256-024-04804-2. Online ahead of print.

Authors

Joshua E Powell¹, Vincent K Lee^{2

3}, Suraj S Parikh⁴, Andrew J Nowalk⁵, Amisha J Shah³

Affiliations

¹ Department of Radiology, Division of Musculoskeletal Imaging, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA. powellj713@gmail.com.
² Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA.
³ Department of Radiology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
⁴ Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
⁵ Department of Pediatrics, Division of Pediatric Infectious Diseases, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.

PMID: 39373749
DOI: 10.1007/s00256-024-04804-2

Abstract

Objective: This study aims to identify distinguishing MRI features of Lyme arthritis (LA), an increasingly prevalent cause of pediatric infectious arthritis in the USA, to enable rapid discrimination from septic arthritis (SA) and facilitate appropriate management.

Materials and methods: A single-center, retrospective analysis was conducted on a convenience sample of pediatric patients with LA in an endemic area using EPIC electronic health record data between January 2010 and December 2020. Patients with positive serologic testing and concurrent MRI were selected. MRI scans were reviewed by a subspecialty-trained pediatric radiologist. Key MRI features analyzed include joint effusion, synovitis, myositis, soft tissue edema, and osseous edema and erosions. MRI features, demographics, and clinical data were compared using univariable and multivariable analyses.

Results: Fifty cases of knee LA and 13 cases of knee SA were included. Larger joint effusion (p = 0.0055, z = - 2.779) and abnormally thickened synovium (p = 0.0011, χ² = 10.622) were more associated with LA. In contrast, increased myositis, subcutaneous edema, and osseous changes were more prevalent in SA. Abnormal bone marrow signal (p < 0.0001, χ² = 36.893) and bone erosion (p < 0.0001, χ² = 25.506) were observed in 84.6% (11/13) and 46.2% (6/13) of SA cases, respectively, while no bone erosion was found in LA.

Conclusion: MRI can be a valuable tool in differentiating LA from SA. Abnormal synovium and increasing joint effusion favor LA, while increasing soft tissue edema and osseous changes favor SA. Notably, the presence of bone erosion effectively excluded LA from consideration.

Keywords: Arthritis; Knee; Lyme; MRI; Pediatric; Septic; Synovitis.