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Purpose <p>Infectious sacroiliitis (ISI) is a rare condition with non-specific symptoms, often leading to delayed diagnosis We aim to describe the clinical, microbiological, and radiological characteristics of infectious sacroiliitis (ISI), and to highlight the diagnostic and follow-up value of imaging modalities.</p> Materials and methods <p>We conducted a retrospective review of 35 ISI cases diagnosed over 27 years. Clinical, microbiological, and imaging data were collected. CT and MRI findings were compared, and follow-up imaging was analyzed when available.</p> Results <p>The mean age was 40.9 years, with a female predominance (60%). Pyogenic organisms were identified in 45.7% of cases, Mycobacterium tuberculosis in 34.3%, and Brucella spp. in 20%. The average diagnostic delay was 102 days. The most frequent symptoms were fever (80%) and buttock pain (77.1%), and inflammatory markers were elevated in approximately 90% of cases. Blood cultures were positive in 6.4%, while biopsy and abscess aspiration confirmed the etiological diagnosis in 28.6% and 14.3%, respectively. Imaging played a central role: CT revealed bony erosions (84.6%) and periarticular involvement (69.2%), while MRI, performed in 13 cases, showed signal abnormalities (85.7%), contrast enhancement (91.7%), and detected soft tissue abscesses (30.8%) and extension to adjacent bone or soft tissues (38.5%). Among the 10 patients who underwent both CT and MRI, MRI detected joint space widening more frequently than CT (70% vs. 50%, <i>p</i> = 0.038) and revealed periarticular infiltration in all cases compared to 60% on CT (<i>p</i> = 0.045). Conversely, CT identified bone sequestra in 50% of patients, whereas none were visualized on MRI (<i>p</i> = 0.041). Radiological follow-up showed improvement in 83.3% of cases, although residual lesions persisted.</p> Conclusion <p>ISI is difficult to diagnose due to its non-specific presentation. Imaging is essential for early diagnosis, guiding treatment, and monitoring response.</p>

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Infectious sacroiliitis: insights from long-term follow-up and the diagnostic contribution of computed tomography and magnetic resonance imaging

  • 期刊论文

  • 发表日期：

    2025年9月4日

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  • Wiem Feki,
  • Amal Chakroun,
  • Amina Kammoun,
  • Fatma Hammami,
  • Khaoula Rekik,
  • Zeineb Mnif,
  • Makram Koubaa,
  • Mounir Ben Jemaa

摘要

Purpose

Infectious sacroiliitis (ISI) is a rare condition with non-specific symptoms, often leading to delayed diagnosis We aim to describe the clinical, microbiological, and radiological characteristics of infectious sacroiliitis (ISI), and to highlight the diagnostic and follow-up value of imaging modalities.

Materials and methods

We conducted a retrospective review of 35 ISI cases diagnosed over 27 years. Clinical, microbiological, and imaging data were collected. CT and MRI findings were compared, and follow-up imaging was analyzed when available.

Results

The mean age was 40.9 years, with a female predominance (60%). Pyogenic organisms were identified in 45.7% of cases, Mycobacterium tuberculosis in 34.3%, and Brucella spp. in 20%. The average diagnostic delay was 102 days. The most frequent symptoms were fever (80%) and buttock pain (77.1%), and inflammatory markers were elevated in approximately 90% of cases. Blood cultures were positive in 6.4%, while biopsy and abscess aspiration confirmed the etiological diagnosis in 28.6% and 14.3%, respectively. Imaging played a central role: CT revealed bony erosions (84.6%) and periarticular involvement (69.2%), while MRI, performed in 13 cases, showed signal abnormalities (85.7%), contrast enhancement (91.7%), and detected soft tissue abscesses (30.8%) and extension to adjacent bone or soft tissues (38.5%). Among the 10 patients who underwent both CT and MRI, MRI detected joint space widening more frequently than CT (70% vs. 50%, p = 0.038) and revealed periarticular infiltration in all cases compared to 60% on CT (p = 0.045). Conversely, CT identified bone sequestra in 50% of patients, whereas none were visualized on MRI (p = 0.041). Radiological follow-up showed improvement in 83.3% of cases, although residual lesions persisted.

Conclusion

ISI is difficult to diagnose due to its non-specific presentation. Imaging is essential for early diagnosis, guiding treatment, and monitoring response.