MRI features distinguishing pediatric Lyme arthritis from septic arthritis

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