{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T03:12:48Z","timestamp":1793157168347,"version":"4.5.0"},"reference-count":25,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,8,12]],"date-time":"2025-08-12T00:00:00Z","timestamp":1754956800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,8,12]],"date-time":"2025-08-12T00:00:00Z","timestamp":1754956800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Skeletal Radiol"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To determine whether decreased femoral head enhancement on MRI differentiates septic arthritis from transient synovitis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>\n                      This retrospective study included children\u2009&lt;\u200910 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\u2019s\n                      <jats:italic>t<\/jats:italic>\n                      -tests and Fisher\u2019s 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.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Thirty-four children were included (20 transient synovitis, 14 septic arthritis). Kocher and modified Kocher scores were significantly higher in septic arthritis (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.003, 0.008). Interobserver agreement for femoral head enhancement was substantial (kappa\u2009=\u20090.70). On consensus read, decreased femoral head enhancement was seen in 71.4% of septic arthritis and 50.0% of transient synovitis cases (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.296). 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.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Decreased 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00256-025-05013-1","type":"journal-article","created":{"date-parts":[[2025,8,12]],"date-time":"2025-08-12T03:32:24Z","timestamp":1754969544000},"page":"181-190","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Can decreased femoral head enhancement differentiate between septic hip arthritis and transient synovitis?"],"prefix":"10.1007","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1674-1789","authenticated-orcid":false,"given":"Boaz","family":"Karmazyn","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher L.","family":"Newman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica M.","family":"Forbes-Amrhein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea M. E. Palazzolo","family":"Ray","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Willa R.","family":"Schmahl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. Gregory","family":"Jennings","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George J.","family":"Eckert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erika L.","family":"Daley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,8,12]]},"reference":[{"issue":"6","key":"5013_CR1","doi-asserted-by":"publisher","first-page":"563","DOI":"10.1097\/BPB.0000000000000828","volume":"30","author":"A Agarwal","year":"2021","unstructured":"Agarwal A, Rastogi P. Septic sequelae of hip in children: long-term clinicoradiological outcome study. J Pediatr Orthop B. 2021;30(6):563\u201371.","journal-title":"J Pediatr Orthop B"},{"issue":"5","key":"5013_CR2","doi-asserted-by":"publisher","first-page":"524","DOI":"10.1097\/BPO.0b013e31817bb079","volume":"28","author":"E Forlin","year":"2008","unstructured":"Forlin E, Milani C. Sequelae of septic arthritis of the hip in children: a new classification and a review of 41 hips. J Pediatr Orthop. 2008;28(5):524\u20138.","journal-title":"J Pediatr Orthop"},{"issue":"3","key":"5013_CR3","doi-asserted-by":"publisher","first-page":"136","DOI":"10.1046\/j.1445-2197.2003.02574.x","volume":"73","author":"D Gandini","year":"2003","unstructured":"Gandini D. Acute septic arthritis of the hip in children in northern Australia. ANZ J Surg. 2003;73(3):136\u20139.","journal-title":"ANZ J Surg"},{"issue":"11","key":"5013_CR4","doi-asserted-by":"publisher","first-page":"1755","DOI":"10.1016\/j.joca.2013.07.013","volume":"21","author":"ID Smith","year":"2013","unstructured":"Smith ID, Winstanley JP, Milto KM, Doherty CJ, Czarniak E, Amyes SG, et al. Rapid in situ chondrocyte death induced by Staphylococcus aureus toxins in a bovine cartilage explant model of septic arthritis. Osteoarthritis Cartilage. 2013;21(11):1755\u201365.","journal-title":"Osteoarthritis Cartilage"},{"issue":"5","key":"5013_CR5","doi-asserted-by":"publisher","first-page":"196","DOI":"10.5435\/JAAOS-D-20-00835","volume":"29","author":"M Erkilinc","year":"2021","unstructured":"Erkilinc M, Gilmore A, Weber M, Mistovich RJ. Current concepts in pediatric septic arthritis. J Am Acad Orthop Surg. 2021;29(5):196\u2013206.","journal-title":"J Am Acad Orthop Surg"},{"issue":"6","key":"5013_CR6","doi-asserted-by":"publisher","first-page":"1109","DOI":"10.1016\/j.pcl.2014.08.002","volume":"61","author":"PC Cook","year":"2014","unstructured":"Cook PC. Transient synovitis, septic hip, and Legg-calv\u00e9-perthes disease: an approach to the correct diagnosis. Pediatr Clin North Am. 2014;61(6):1109\u201318.","journal-title":"Pediatr Clin North Am"},{"issue":"4","key":"5013_CR7","doi-asserted-by":"publisher","first-page":"471","DOI":"10.1016\/j.ocl.2024.04.004","volume":"55","author":"CD Pargas-Colina","year":"2024","unstructured":"Pargas-Colina CD. Transient\/toxic synovitis. Orthop Clin North Am. 2024;55(4):471\u20137.","journal-title":"Orthop Clin North Am"},{"key":"5013_CR8","doi-asserted-by":"publisher","DOI":"10.3390\/microorganisms12030550","author":"S Valisena","year":"2024","unstructured":"Valisena S, De Marco G, Vazquez O, Cochard B, Steiger C, Dayer R, et al. The Kocher-Caird criteria for pediatric septic arthritis of the hip: time for a change in the Kingella era? Microorganisms. 2024. https:\/\/doi.org\/10.3390\/microorganisms12030550.","journal-title":"Microorganisms"},{"issue":"8","key":"5013_CR9","doi-asserted-by":"publisher","first-page":"1629","DOI":"10.2106\/00004623-200408000-00005","volume":"86","author":"MS Kocher","year":"2004","unstructured":"Kocher MS, Mandiga R, Zurakowski D, Barnewolt C, Kasser JR. Validation of a clinical prediction rule for the differentiation between septic arthritis and transient synovitis of the hip in children. J Bone Joint Surg Am. 2004;86(8):1629\u201335.","journal-title":"J Bone Joint Surg Am"},{"issue":"12","key":"5013_CR10","doi-asserted-by":"publisher","first-page":"1662","DOI":"10.2106\/00004623-199912000-00002","volume":"81","author":"MS Kocher","year":"1999","unstructured":"Kocher MS, Zurakowski D, Kasser JR. Differentiating between septic arthritis and transient synovitis of the hip in children: an evidence-based clinical prediction algorithm. J Bone Joint Surg Am. 1999;81(12):1662\u201370.","journal-title":"J Bone Joint Surg Am"},{"issue":"2","key":"5013_CR11","doi-asserted-by":"publisher","first-page":"e212","DOI":"10.1097\/BPO.0000000000002024","volume":"42","author":"AJ Nickel","year":"2022","unstructured":"Nickel AJ, Bretscher BS, Truong WH, Laine JC, Kharbanda AB. Novel uses of traditional algorithms for septic arthritis. J Pediatr Orthop. 2022;42(2):e212-7.","journal-title":"J Pediatr Orthop"},{"issue":"6","key":"5013_CR12","doi-asserted-by":"publisher","first-page":"1251","DOI":"10.2106\/JBJS.E.00216","volume":"88","author":"MS Caird","year":"2006","unstructured":"Caird MS, Flynn JM, Leung YL, Millman JE, D\u2019Italia JG, Dormans JP. Factors distinguishing septic arthritis from transient synovitis of the hip in children. A prospective study. J Bone Joint Surg Am. 2006;88(6):1251\u20137.","journal-title":"J Bone Joint Surg Am"},{"issue":"6","key":"5013_CR13","doi-asserted-by":"publisher","first-page":"1289","DOI":"10.2214\/AJR.14.12891","volume":"204","author":"J Monsalve","year":"2015","unstructured":"Monsalve J, Kan JH, Schallert EK, Bisset GS, Zhang W, Rosenfeld SB. Septic arthritis in children: frequency of coexisting unsuspected osteomyelitis and implications on imaging work-up and management. AJR Am J Roentgenol. 2015;204(6):1289\u201395.","journal-title":"AJR Am J Roentgenol"},{"issue":"2","key":"5013_CR14","doi-asserted-by":"publisher","first-page":"437","DOI":"10.2214\/AJR.07.2080","volume":"189","author":"KS Kwack","year":"2007","unstructured":"Kwack KS, Cho JH, Lee JH, Cho JH, Oh KK, Kim SY. Septic arthritis versus transient synovitis of the hip: gadolinium-enhanced MRI finding of decreased perfusion at the femoral epiphysis. AJR Am J Roentgenol. 2007;189(2):437\u201345.","journal-title":"AJR Am J Roentgenol"},{"issue":"2","key":"5013_CR15","doi-asserted-by":"publisher","first-page":"428","DOI":"10.2214\/AJR.11.6937","volume":"198","author":"EY Kim","year":"2012","unstructured":"Kim EY, Kwack KS, Cho JH, Lee DH, Yoon SH. Usefulness of dynamic contrast-enhanced MRI in differentiating between septic arthritis and transient synovitis in the hip joint. AJR Am J Roentgenol. 2012;198(2):428\u201333.","journal-title":"AJR Am J Roentgenol"},{"issue":"3","key":"5013_CR16","doi-asserted-by":"publisher","first-page":"676","DOI":"10.2214\/AJR.16.17685","volume":"209","author":"MM Forbes-Amrhein","year":"2017","unstructured":"Forbes-Amrhein MM, Marine MB, Wanner MR, Roth TD, Davis JT, Ravi AK, et al. Journal club: can coronal STIR be used as screening for acute nontraumatic hip pain in children? AJR Am J Roentgenol. 2017;209(3):676\u201383.","journal-title":"AJR Am J Roentgenol"},{"issue":"6","key":"5013_CR17","doi-asserted-by":"publisher","first-page":"994","DOI":"10.2106\/00004623-200306000-00002","volume":"85","author":"MS Kocher","year":"2003","unstructured":"Kocher MS, Mandiga R, Murphy JM, Goldmann D, Harper M, Sundel R, et al. A clinical practice guideline for treatment of septic arthritis in children: efficacy in improving process of care and effect on outcome of septic arthritis of the hip. J Bone Joint Surg Am. 2003;85(6):994\u20139.","journal-title":"J Bone Joint Surg Am"},{"issue":"1","key":"5013_CR18","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1097\/BPO.0000000000000389","volume":"36","author":"S Rosenfeld","year":"2016","unstructured":"Rosenfeld S, Bernstein DT, Daram S, Dawson J, Zhang W. Predicting the presence of adjacent infections in septic arthritis in children. J Pediatr Orthop. 2016;36(1):70\u20134.","journal-title":"J Pediatr Orthop"},{"issue":"2","key":"5013_CR19","doi-asserted-by":"publisher","first-page":"459","DOI":"10.1148\/radiology.211.2.r99ma47459","volume":"211","author":"SK Lee","year":"1999","unstructured":"Lee SK, Suh KJ, Kim YW, Ryeom HK, Kim YS, Lee JM, et al. Septic arthritis versus transient synovitis at MR imaging: preliminary assessment with signal intensity alterations in bone marrow. Radiology. 1999;211(2):459\u201365.","journal-title":"Radiology"},{"issue":"11","key":"5013_CR20","doi-asserted-by":"publisher","first-page":"1154","DOI":"10.1007\/s00247-006-0289-9","volume":"36","author":"WJ Yang","year":"2006","unstructured":"Yang WJ, Im SA, Lim GY, Chun HJ, Jung NY, Sung MS, et al. MR imaging of transient synovitis: differentiation from septic arthritis. Pediatr Radiol. 2006;36(11):1154\u20138.","journal-title":"Pediatr Radiol"},{"issue":"3","key":"5013_CR21","doi-asserted-by":"publisher","first-page":"297","DOI":"10.1097\/BPB.0000000000000671","volume":"29","author":"MS Kang","year":"2020","unstructured":"Kang MS, Jeon JY, Park SS. Differential MRI findings of transient synovitis of the hip in children when septic arthritis is suspected according to symptom duration. J Pediatr Orthop B. 2020;29(3):297\u2013303.","journal-title":"J Pediatr Orthop B"},{"key":"5013_CR22","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejro.2022.100439","volume":"9","author":"M Adam","year":"2022","unstructured":"Adam M, Ibrahim B, Khidir R, Elmahdi E, Ahmed S, Ahmed A. Usefulness of MRI findings in differentiating between septic arthritis and transient synovitis of hip joint in children: a systematic review and meta-analysis. Eur J Radiol Open. 2022;9: 100439.","journal-title":"Eur J Radiol Open"},{"issue":"3","key":"5013_CR23","doi-asserted-by":"publisher","first-page":"204","DOI":"10.3109\/17453678508992995","volume":"56","author":"H Wingstrand","year":"1985","unstructured":"Wingstrand H, Egund N, Carlin NO, Forsberg L, Gustafson T, Sund\u00e9n G. Intracapsular pressure in transient synovitis of the hip. Acta Orthop Scand. 1985;56(3):204\u201310.","journal-title":"Acta Orthop Scand"},{"issue":"8","key":"5013_CR24","first-page":"e66184","volume":"16","author":"J Hanna","year":"2024","unstructured":"Hanna J, Rashid R, Hanna M, Elkomos BE, Bahadoor V, Ebeidallah G. Paediatric septic arthritis of the hip and the efficacy of Kocher\u2019s criteria: a literature review. Cureus. 2024;16(8):e66184.","journal-title":"Cureus"},{"issue":"3","key":"5013_CR25","doi-asserted-by":"publisher","first-page":"325","DOI":"10.1016\/j.pedneo.2020.02.006","volume":"61","author":"E Cohen","year":"2020","unstructured":"Cohen E, Katz T, Rahamim E, Bulkowstein S, Weisel Y, Leibovitz R, et al. Septic arthritis in children: updated epidemiologic, microbiologic, clinical and therapeutic correlations. Pediatr Neonatol. 2020;61(3):325\u201330.","journal-title":"Pediatr Neonatol"}],"container-title":["Skeletal Radiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00256-025-05013-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00256-025-05013-1","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00256-025-05013-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,24]],"date-time":"2025-12-24T13:51:22Z","timestamp":1766584282000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00256-025-05013-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,12]]},"references-count":25,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["5013"],"URL":"https:\/\/doi.org\/10.1007\/s00256-025-05013-1","relation":{},"ISSN":["0364-2348","1432-2161"],"issn-type":[{"value":"0364-2348","type":"print"},{"value":"1432-2161","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,12]]},"assertion":[{"value":"11 June 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 July 2025","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 August 2025","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 August 2025","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and\/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}