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Mri Findings Of Infectious Sacroiliitis; Pyogenic Versus Tuberculosis 2014

Category General Spine Yu Mi Jeong Su Young Park Sheen-Woo Lee Purpose The purpose of this study is to describe the MRI findings of infectious sacroiliitis, and to describe distinguishing features of pyogenic sacroiliitis and tuberculous sacroiliitis. Materials & Methods We retrospectively searched for MRI of sacroiliitis through our PACS database and reviewed MRI findings of infectious sacroiliitis diagnosed between 2005 and 2013 in our hospital. Twelve patients of confirmed infectious sacroiliitis were included in this study. We analyzed MRI findings by grading bone marrow edema, joint effusion, periarticular soft tissue inflammation, periarticular abscess (small or large) and presence of intraosseous abscess. Results Seven patients were confirmed as pyogenic sacroiliitis, by means of joint aspiration, surgery and/or blood culture. Five patients were confirmed as tuberculous sacroiliitis including one patient with bilateral sacroiliitis, by means of joint aspiration, surgery and/or concomitant active pulmonary tuberculosis. Tuberculous sacroiliitis showed large abscess formation (3/6) and relatively mild periarticular soft tissue inflammation. On the other hand, pyogenic sacroiliitis showed extensive periarticular soft tissue inflammation (7/7). Piriformis muscle and greater sciatic foramen were involved in all cases of pyogenic sacroiliitis, whereas only one piriformis muscle and 2 greater sciatic foramina were involved in tuberculous sacroiliitis. Conclusion Although this is a limited study of small patient population, we suggest that MRI evaluation of the extent of periarticular soft tissue inflammation may be helpful to differentiate pyogenic and tuberculous sacroiliitis. Large periarticular soft tissue abscesses and intraosseous abscesses were only found in tuberculous sacroiliitis. References 1. Hermet M, Minichiello E, Flipo RM et al. Infectious sacroiliitis: a retrospective, multicentre study of 39 adults. BMC infectious diseases. 2012; 12:305 2. Feldmann JL, Menkes CJ, Weill B et al. Infectious sacroiliitis. Multicenter study of 214 cases. Rev Rhum Mal Osteoartic. 1981; 48(1):83-91 3. Panayiotis JP, Elias CP, Andreas FM et al. Tuberculous sacroiliitis. A case report and review of the literature. Eur Spine J 2005; 14:683-688 4. R. J. S. Ramlakan, S. Govender. Sacroiliac joint tuberculosis. Int Orthop. 2007; 31:121-124 5. Wada A, Takamura K, Fujii T, Yanagida H et al. Septic sacroiliitis in children. J Pediatr Orthop. 2008; 28(4):488-492. 6. Tan CH, Vikram R, Boonsirikamchai P et al. Pathways of extrapelvic spread of pelvic disease: imaging findings. Radiographics 2011;31:117-133