Septic arthritis versus transient synovitis of the hip: gadolinium-enhanced MRI finding of decreased perfusion at the femoral epiphysis.

Abstract

OBJECTIVE: The purpose of this study was to identify differences in the MRI findings of septic arthritis and transient synovitis in patients with nontraumatic acute hip pain and hip effusion.

MATERIALS AND METHODS: The MRI findings in nine patients with septic arthritis and 11 with transient synovitis were reviewed retrospectively. This study was approved by our institutional review board. The diagnoses were based on findings at physical examination, laboratory studies, and joint aspiration and bacteriologic study. The MRI findings were analyzed with emphasis on the grade of joint effusion, alterations in signal intensity in the soft tissues and bone marrow, and the presence of decreased perfusion at the femoral head.

RESULTS: Low signal intensity on fat-suppressed gadolinium-enhanced T1-weighted coronal MRI suggesting decreased perfusion at the femoral head of the affected hip joint was seen in eight of nine patients with septic arthritis and in two of 11 patients with transient synovitis. Statistically reliable differences (p = 0.005) were found between the two groups. Alterations in signal intensity in the bone marrow were seen in three patients with septic arthritis but in none of the patients with transient synovitis. Decreased perfusion on fat-suppressed gadolinium-enhanced coronal T1-weighted MRI was seen in the six patients with septic arthritis who did not have alterations in signal intensity involving the bone marrow.

CONCLUSION: Decreased perfusion at the femoral epiphysis on fat-suppressed gadolinium-enhanced coronal T1-weighted MRI is useful for differentiating septic arthritis from transient synovitis.