Top

Pediatric Radiology

Published in:

Open Access 01-04-2011 | Original Article

Differences in MRI findings between subgroups of recent-onset childhood arthritis

Authors: Eva Kirkhus, Berit Flatø, Øystein Riise, Tor Reiseter, Hans-Jørgen Smith

Published in: Pediatric Radiology | Issue 4/2011

Abstract

Background

MRI is sensitive for joint inflammation, but its ability to separate subgroups of arthritis in children has been questioned. Infectious arthritis (IA), postinfectious arthritis (PA), transient arthritis (TA) and juvenile idiopathic arthritis (JIA) are subgroups that may need early, different treatment.

Objective

To determine whether MRI findings differ in IA, PA/TA and JIA in recent-onset childhood arthritis.

Materials and methods

Fifty-nine children from a prospective study of incidence of arthritis (n = 216) were, based on clinical and biochemical criteria, examined by MRI. Joint fluid, synovium, bone marrow, soft tissue and cartilage were scored retrospectively and analysed by Pearson chi-square test and logistic regression analysis.

Results

Fifty-nine children had MRI of one station. IA was suggested by bone marrow oedema (OR 7.46, P = 0.011) and absence of T1-weighted and T2-weighted low signal intensity synovial tissue (OR 0.06, P = 0.015). Furthermore, soft-tissue oedema and reduced contrast enhancement in the epiphyses were more frequent in children with IA. JIA correlated positively with low signal intensity synovial tissue (OR 13.30, P < 0.001) and negatively with soft-tissue oedema (OR 0.20, P = 0.018). No significant positive determinants were found for PA/TA, but bone marrow oedema, soft-tissue oedema, irregular thickened synovium and low signal intensity synovial tissue was less frequent than in IA/JIA.

Conclusion

In children with high clinical suspicion of recent onset arthritis, there was a significant difference in the distribution of specific MRI features among the diagnostic groups.

Bancroft LW (2007) MR imaging of infectious processes of the knee. Radiol Clin North Am 45:931–941PubMedCrossRef

Buchmann RF, Jaramillo D (2004) Imaging of articular disorders in children. Radiol Clin North Am 42:151–168PubMedCrossRef

Lamer S, Sebag GH (2000) MRI and ultrasound in children with juvenile chronic arthritis. Eur J Radiol 33:85–93PubMedCrossRef

Petty RE (1999) Prognosis in children with rheumatic diseases: justification for consideration of new therapies. Rheumatol (Oxf) 38:739–742CrossRef

Weston VC, Jones AC, Bradbury N et al (1999) Clinical features and outcome of septic arthritis in a single UK Health District 1982–1991. Ann Rheum Dis 58:214–219PubMedCrossRef

Wang CL, Wang SM, Yang YJ et al (2003) Septic arthritis in children: relationship of causative pathogens, complications, and outcome. J Microbiol Immunol Infect 36:41–46PubMed

Vidigal EC Jr, Vidigal EC, Fernandes JL (1997) Avascular necrosis as a complication of septic arthritis of the hip in children. Int Orthop 21:389–392PubMedCrossRef

Flato B, Aasland A, Vinje O et al (1998) Outcome and predictive factors in juvenile rheumatoid arthritis and juvenile spondyloarthropathy. J Rheumatol 25:366–375PubMed

Kocher MS, Zurakowski D, Kasser JR (1999) Differentiating between septic arthritis and transient synovitis of the hip in children: an evidence-based clinical prediction algorithm. J Bone Joint Surg Am 81:1662–1670PubMed

10.

Lyon RM, Evanich JD (1999) Culture-negative septic arthritis in children. J Pediatr Orthop 19:655–659PubMedCrossRef

11.

Perlman MH, Patzakis MJ, Kumar PJ et al (2000) The incidence of joint involvement with adjacent osteomyelitis in pediatric patients. J Pediatr Orthop 20:40–43PubMedCrossRef

12.

Yang W, Im S, Lim GY et al (2006) MR imaging of transient synovitis: differentiation from septic arthritis. Pediatr Radiol 36:1154–1158PubMedCrossRef

13.

Lee SK, Suh KJ, Kim YW et al (1999) Septic arthritis versus transient synovitis at MR imaging: preliminary assessment with signal intensity alterations in bone marrow. Radiology 211:459–465PubMed

14.

Kwack KS, Cho JH, Lee JH et al (2007) Septic arthritis versus transient synovitis of the hip: gadolinium-enhanced MRI finding of decreased perfusion at the femoral epiphysis. AJR 189:437–445PubMedCrossRef

15.

Argyropoulou MI, Fanis SL, Xenakis T et al (2002) The role of MRI in the evaluation of hip joint disease in clinical subtypes of juvenile idiopathic arthritis. Br J Radiol 75:229–233PubMed

16.

Gardner-Medwin JM, Killeen OG, Ryder CA et al (2006) Magnetic resonance imaging identifies features in clinically unaffected knees predicting extension of arthritis in children with monoarthritis. J Rheumatol 33:2337–2343PubMed

17.

Johnson K, Wittkop B, Haigh F et al (2002) The early magnetic resonance imaging features of the knee in juvenile idiopathic arthritis. Clin Radiol 57:466–471PubMedCrossRef

18.

Murray JG (1996) Juvenile chronic arthritis of the hip: value of contrast-enhanced MR imaging. Clin Radiol 51:99–102PubMedCrossRef

19.

Riise OR, Handeland KS, Cvancarova M et al (2008) Incidence and characteristics of arthritis in Norwegian children: a population-based study. Pediatrics 121:e299–e306PubMedCrossRef

20.

Petty RE, Southwood TR, Manners P et al (2004) International League of Associations for Rheumatology International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. J Rheumatol 31:390–392PubMed

21.

Mitchell DG, Rao V, Dalinka M et al (1986) MRI of joint fluid in the normal and ischemic hip. AJR 146:1215–1218PubMed

22.

Gylys-Morin VM, Graham TB, Blebea JS et al (2001) Knee in early juvenile rheumatoid arthritis: MR imaging findings. Radiology 220:696–706PubMedCrossRef

23.

Petty RE, Cassidy JT (2005) Structure and function. In: Petty RE, Cassidy JT (eds) Textbook of pediatric rheumatology, 5th edn. Elsevier Saunders, Philadelphia, pp 9–18

24.

Shabshin N, Schweitzer ME, Morrison WB et al (2006) High-signal T2 changes of the bone marrow of the foot and ankle in children: red marrow or traumatic changes? Pediatr Radiol 36:670–676PubMedCrossRef

25.

Gattorno M, Martini A (2005) The immune system and the inflammatory response. In: Petty RE, Cassidy JT (eds) Textbook of pediatric rheumatology, 5th edn. Elsevier Saunders, Philadelphia, pp 19–63CrossRef

26.

Riise OR, Kirkhus ES, Handeland K et al (2008) Childhood osteomyelitis-incidence and differentiation from other acute onset musculoskeletal features in a population-based study. BMC Pediatr 8:45PubMedCrossRef

Title: Differences in MRI findings between subgroups of recent-onset childhood arthritis
Authors: Eva Kirkhus
Berit Flatø
Øystein Riise
Tor Reiseter
Hans-Jørgen Smith
Publication date: 01-04-2011
Publisher: Springer-Verlag
Published in: Pediatric Radiology / Issue 4/2011
Print ISSN: 0301-0449
Electronic ISSN: 1432-1998
DOI: https://doi.org/10.1007/s00247-010-1897-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Differences in MRI findings between subgroups of recent-onset childhood arthritis

Abstract

Background

Objective

Materials and methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Objective

Materials and methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 4/2011

Gadopentetate dimeglumine-enhanced MR cholangiopancreatography in infants with cholestasis

MRI of vulvar Crohn disease

Pediatric Radiology Continuing Medical Education Activity

Neuroblastoma with primary pleural involvement: an unusual presentation

Role of MRI in osteosarcoma for evaluation and prediction of chemotherapy response: correlation with histological necrosis

Skeletal imaging effects of pamidronate therapy in osteosarcoma patients