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18-12-2023 | Osteomyelitis | Scientific Article

Infectious sacroiliitis: MRI- and CT-based assessment of disease extent, complications, and anatomic correlation

Authors: Sarah Interligator, Antoine Le Bozec, Guillaume Cluzel, Matthieu Devilder, Jessica Ghaouche, Daphne Guenoun, Albane Fleury, Florian Petit Lemaire, Robert-Yves Carlier, Catarina Valente, Maud Creze

Published in: Skeletal Radiology | Issue 10/2024

Abstract

Objective

To describe the frequency of MR and CT features of infectious sacroiliitis (ISI) and assess its extent and complications

Materials and methods

This retrospective study included patients with ISI who were evaluated between 2008 and 2021 in a single center. Two radiologists reviewed MRI and CT images to determine the anatomical distribution (unilateral/bilateral, iliac/sacral bone, proximal/middle/distal), severity (bone marrow edema [BME]/periostitis/erosions), concurrent infection (vertebral/nonvertebral), and complications (abscess/probable adjacent osteomyelitis/cavitation/devitalized areas/sequestrum/pelvic venous thrombosis) of ISI. Interobserver reproducibility was assessed. Correlation analysis evaluated the effect of the causative microorganism on severity. Two human bodies were dissected to outline possible ways that ISI can spread.

Results

Forty patients with ISI (40 years ± 22; 26 women) were evaluated. Ten patients had bilateral ISI. Concurrent vertebral infection was associated in 15% of cases. Reproducibility of sacral BME, periostitis, and reactive locoregional abnormalities was perfect (κ = 1). Reproducibility was low for erosion count (κ = 0.52[0.52–0.82]) and periarticular osteopenia (κ = 0.50[0.18–0.82]). Inflammatory changes were BME (42/42 joints), muscle edema (38/42), and severe periostitis along the ilium (33/37). Destructive structural changes occurred with confluent erosions (iliac, 20/48; sacral, 13/48), sequestrum (20/48), and cavitation (12/48). Complications occurred in 75% of cases, including periarticular abscesses (n = 30/47), probable adjacent osteomyelitis (n = 16/37), and pelvic thrombophlebitis (n = 3). Tuberculous ISI (6/40) correlated with sclerosis (rs = 0.45[0.16; 0.67]; p < 10⁻²) and bone devitalization (rs = 0.38[0.16; 0.67]; p = .02). The anatomical study highlighted the shared venous vascularization of sacroiliac joints, pelvic organs, and mobile spine.

Conclusion

Complications of ISI are frequent, including abscesses, adjacent osteomyelitis, and periostitis. ISI had bilateral involvement nonrarely and is commonly associated with another spinal infection.

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Title: Infectious sacroiliitis: MRI- and CT-based assessment of disease extent, complications, and anatomic correlation
Authors: Sarah Interligator
Antoine Le Bozec
Guillaume Cluzel
Matthieu Devilder
Jessica Ghaouche
Daphne Guenoun
Albane Fleury
Florian Petit Lemaire
Robert-Yves Carlier
Catarina Valente
Maud Creze
Publication date: 18-12-2023
Publisher: Springer Berlin Heidelberg
Keywords: Osteomyelitis
Edema
Published in: Skeletal Radiology / Issue 10/2024
Print ISSN: 0364-2348
Electronic ISSN: 1432-2161
DOI: https://doi.org/10.1007/s00256-023-04535-w

ERS Congress 2024

Springer Medicine

Infectious sacroiliitis: MRI- and CT-based assessment of disease extent, complications, and anatomic correlation

Abstract

Objective

Materials and methods

Results

Conclusion

ERS Congress 2024

Springer Medicine

Abstract

Objective

Materials and methods

Results

Conclusion

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