Powell Joshua E, Lee Vincent K, Parikh Suraj S, Nowalk Andrew J, Shah Amisha J
Department of Radiology, Division of Musculoskeletal Imaging, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA.
Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA.
Skeletal Radiol. 2025 May;54(5):1043-1057. doi: 10.1007/s00256-024-04804-2. Epub 2024 Oct 7.
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.
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.
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, χ = 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, χ = 36.893) and bone erosion (p < 0.0001, χ = 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.
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.
本研究旨在确定莱姆关节炎（LA）的特征性MRI表现，在美国，LA是儿童感染性关节炎日益常见的病因，本研究有助于快速鉴别LA与化脓性关节炎（SA），并促进适当的治疗。
在2010年1月至2020年12月期间，利用EPIC电子健康记录数据，对流行地区患有LA的儿科患者的便利样本进行了单中心回顾性分析。选择血清学检测呈阳性且同时进行MRI检查的患者。由经过亚专业培训的儿科放射科医生对MRI扫描结果进行评估。分析的关键MRI特征包括关节积液、滑膜炎、肌炎、软组织水肿、骨水肿和骨侵蚀。使用单变量和多变量分析比较MRI特征、人口统计学和临床数据。
纳入50例膝关节LA患者和13例膝关节SA患者。较大的关节积液（p = 0.0055，z = - 2.779）和滑膜异常增厚（p = 0.0011，χ = 10.622）与LA的相关性更强。相比之下，SA中肌炎、皮下水肿和骨质改变更为常见。84.6%（11/13）的SA病例观察到骨髓信号异常（p < 0.0001，χ = 36.893），46.2%（6/13）的SA病例观察到骨侵蚀（p < 0.0001，χ = 25.506），而LA中未发现骨侵蚀。
MRI可作为区分LA与SA的有价值工具。滑膜异常和关节积液增加提示LA，而软组织水肿和骨质改变增加提示SA。值得注意的是，骨侵蚀的存在有效地排除了LA的可能性。
