Evidence map›Paper›PMID 40794327›Full record

ArticleSkeletal radiology2026

Can decreased femoral head enhancement differentiate between septic hip arthritis and transient synovitis?

Boaz Karmazyn, Christopher L Newman, Monica M Forbes-Amrhein, Andrea M E Palazzolo Ray, Willa R Schmahl, S Gregory Jennings, George J Eckert, Erika L Daley

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Skeletal radiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Boaz KarmazynDepartment of Radiology and Imaging Sciences, Riley Hospital for Children at IU Health, Indiana University School of Medicine, 705 Riley Hospital Dr., Indianapolis, IN, 46202, USA. Bkarmazy@iu.edu.ORCID http://orcid.org/0000-0003-1674-1789
Christopher L NewmanDepartment of Radiology and Imaging Sciences, Riley Hospital for Children at IU Health, Indiana University School of Medicine, 705 Riley Hospital Dr., Indianapolis, IN, 46202, USA.
Monica M Forbes-AmrheinDepartment of Radiology and Imaging Sciences, Riley Hospital for Children at IU Health, Indiana University School of Medicine, 705 Riley Hospital Dr., Indianapolis, IN, 46202, USA.
Andrea M E Palazzolo RayDepartment of Orthopaedic Surgery, Indiana University Hospital, Indiana University Health University Hospital, Indiana University School of Medicine, 550 N. University Blvd., Suite 6201, Indianapolis, IN, 46202, USA.
Willa R SchmahlDepartment of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, 259 E Erie St., Chicago, IL, 60611, USA.
S Gregory JenningsDepartment of Radiology and Imaging Sciences, Indiana University School of Medicine, 950 W. Walnut Street Rm E124, Indianapolis, IN, 46202, USA.
George J EckertDepartment of Biostatistics and Health Data Science, Indiana University School of Medicine, 340 West 10th Street Fairbanks Hall, Indianapolis, IN, 46202, USA.
Erika L DaleyDepartment of Pediatric Orthopedics and Sports Medicine, Riley Hospital for Children at IU Health, Indiana University School of Medicine, 575 Riley Hospital Dr., Indianapolis, IN, 46202, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo determine whether decreased femoral head enhancement on MRI differentiates septic arthritis from transient synovitis. MATERIALS AND

methodsThis retrospective study included children < 10 years old with hip effusion on post-contrast MRI for suspected musculoskeletal infection. Two pediatric radiologists independently assessed femoral head enhancement. Kocher and modified Kocher scores were calculated from clinical and lab data. Differences between septic arthritis and transient synovitis were analyzed using Student's t-tests and Fisher's exact tests. Sensitivity and specificity for diagnosing septic arthritis were calculated for Kocher scores, their individual components, decreased femoral head enhancement, and muscle edema. Interobserver agreement was assessed.

resultsThirty-four children were included (20 transient synovitis, 14 septic arthritis). Kocher and modified Kocher scores were significantly higher in septic arthritis (p = 0.003, 0.008). Interobserver agreement for femoral head enhancement was substantial (kappa = 0.70). On consensus read, decreased femoral head enhancement was seen in 71.4% of septic arthritis and 50.0% of transient synovitis cases (p = 0.296). Bone marrow edema was present in two septic arthritis cases. Muscle edema had moderate to high sensitivity (71.4%, 92.9%) but moderate to low specificity (75.0%, 50.0%) for septic arthritis.

conclusionDecreased femoral head enhancement does not reliably distinguish septic arthritis from transient synovitis. Relying on this finding alone may lead to unnecessary interventions in children with transient synovitis. Muscle edema and bone marrow edema may support the diagnosis of septic arthritis. Clinical evaluation and inflammatory markers remain critical in guiding decisions for hip aspiration.

Indexed as

Arthritis, InfectiousFemur HeadHip JointMagnetic Resonance ImagingSynovitisChildChild, PreschoolContrast MediaDiagnosis, DifferentialFemaleHumansInfantMaleRetrospective StudiesSensitivity and SpecificityContrast MediaDecreased enhancementMRISeptic arthritisTransient synovitis

Identifiers

PMID40794327
PMCPMC12627202

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.