Balakrishna P. Shetty MBBS, MD, Presenter: Nothing to Disclose

Chronic Joint effusions without acute infective symptoms could be due non infective arthritis or due to Granulomatous Infection. Tuberculous Artritis is a common granulomatous disease in this part of the world. Joint fluid analysis and culture is often inconclusive. The purpose of our study is to differentiate tuberculous effusions from other non infective joint effusions.

65 patients with chronic joint effusion were studied by T1, STIR, Diffusion ( b=0, b=1000) weighted sequences in axial and coronal planes. Totally 25 Hip, 20 Knee, 8 ankle, 8 shoulder, 4 elbow cases were studied. Only 22 patients with culture proved tuberculous disease included in this study. All these patients showed diffusion Hyper intensity. Out of the remaining 43 patients Diffusion hyper intensity was noted in 15 patients. On histopathology of the synovium11 of these patients showed tuberculous disease and 4 of them showed nonspecific granulomatous infection. 28 joint effusions did not show diffusion hyper intensity and there was no evidence of infection in Culture/ Histopathology.

All 22 culture proved tuberculous joint effusions showed diffusion Hyper intensity. Diffusion hyperintensity was not seen in non infective effusions.

Diffusion Hyperintensity in Joint fluid represents infective process. In clinical setting of chronic effusions these effusions are due to Tuberculosis especially in this part of the world. Culture and Histopathology is often not possible or negative in these patients. In such situations Diffusion weighted imaging will help in identifying infective process.

Diffusion weighted imaging helps in differentiating infective and non infective joint effusions. This is extremely useful in chronic conditions such as tuberculosis.

Shetty, B, Diffusion-weighted Imaging in Differentiating Tuberculous Arthritis from Non-infective Arthritis.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9013596.html