Skeletal Radiology

, Volume 47, Issue 4, pp 473–482 | Cite as

Percutaneous CT-guided sacroiliac joint sampling for infection: aspiration, biopsy, and technique

  • David Knipp
  • F. Joseph Simeone
  • Sandra B. Nelson
  • Ambrose J. Huang
  • Connie Y. Chang
Scientific Article



To evaluate methods of CT-guided sacroiliac joint sampling in patients with suspected infection.

Materials and methods

All CT-guided sacroiliac joint sampling procedures for suspected infection were reviewed for sampling type (aspiration, lavage aspiration, biopsy), microbiology results, and clinical and imaging follow-up. The primary gold standard was anatomic pathology. If pathology was not available, then positive blood culture with the same organism as SIJ sampling, imaging and clinical follow-up, or clinical follow-up only were used. Anterior and posterior joint distention was evaluated by MRI within 7 days of the procedure.


A total of 34 patients (age 39 ± 20 (range, 6–75) years; 21 F, 13 M) were included. Aspiration samples only were obtained in 13/34 (38%) cases, biopsy samples only in 9/34 (26%) cases, and both samples in 12/34 (35%) cases. There was an overall 54% sensitivity and 86% specificity. For the aspiration samples, sensitivity and specificity were 60 and 81%, respectively, compared to 45 and 90% for the biopsy samples. In cases with both samples, biopsy did not add additional microbial information. Seventeen (17/34, 50%) patients had an MRI. The anterior joint was more distended than the posterior joint in 15/17 (88%) of patients, and this difference was significant (P = 0.0003). All of these 17 patients had an attempted aspiration by a posterior approach; 6/17 (35%) resulted in a successful aspiration.


Aspiration of the sacroiliac joint has a higher sensitivity than biopsy and should always be attempted first. MRI may be helpful for procedure planning.


Sacroiliac joint Septic arthritis CT-guided aspiration Biopsy Osteomyelitis 


Compliance with ethical standards

This investigation was approved by the Institutional Review Board and was compliant with the Health Insurance Portability and Accountability Act (HIPAA) guidelines. 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.

Conflict of interest

The aforementioned authors have no conflicts of interest to disclose.


  1. 1.
    Kok HK, Mumtaz A, O’Brien C, Kane D, Torreggiani WC, Delaney H. Imaging the patient with sacroiliac pain. Can Assoc Radiol J. 2016;67(1):41–51.CrossRefPubMedGoogle Scholar
  2. 2.
    Wu M-S, Chang S-S, Lee S-H, Lee C-C. Pyogenic sacroiliitis—a comparison between paediatric and adult patients. Rheumatol Oxf Engl. 2007;46(11):1684–7.CrossRefGoogle Scholar
  3. 3.
    Hermet M, Minichiello E, Flipo RM, Dubost JJ, Allanore Y, Ziza JM, et al. Infectious sacroiliitis: a retrospective, multicentre study of 39 adults. BMC Infect Dis. 2012;12:305.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Miskew DB, Block RA, Witt PF. Aspiration of infected sarco-iliac joints. J Bone Joint Surg Am. 1979;61(7):1071–2.CrossRefPubMedGoogle Scholar
  5. 5.
    Aprin H, Turen C. Pyogenic sacroiliitis in children. Clin Orthop. 1993;287:98–106.Google Scholar
  6. 6.
    Grippi M, Zionts LE, Ahlmann ER, Forrester DM, Patzakis MJ. The early diagnosis of sacroiliac joint infections in children. J Pediatr Orthop. 2006;26(5):589–93.CrossRefPubMedGoogle Scholar
  7. 7.
    Osman AA, Govender S. Septic sacroiliitis. Clin Orthop. 1995;313:214–9.Google Scholar
  8. 8.
    White LM, Schweitzer ME, Deely DM, Gannon F. Study of osteomyelitis: utility of combined histologic and microbiologic evaluation of percutaneous biopsy samples. Radiology. 1995;197(3):840–2.CrossRefPubMedGoogle Scholar
  9. 9.
    Chang CY, Simeone FJ, Nelson SB, Taneja AK, Huang AJ. Is biopsying the paravertebral soft tissue as effective as biopsying the disk or vertebral endplate? 10-year retrospective review of CT-guided biopsy of diskitis–osteomyelitis. AJR Am J Roentgenol. 2015;205(1):123–9.CrossRefPubMedGoogle Scholar
  10. 10.
    Vleeming A, Schuenke MD, Masi AT, Carreiro JE, Danneels L, Willard FH. The sacroiliac joint: an overview of its anatomy, function and potential clinical implications. J Anat. 2012;221(6):537–67.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Forst SL, Wheeler MT, Fortin JD, Vilensky JA. The sacroiliac joint: anatomy, physiology and clinical significance. Pain Physician. 2006;9(1):61–7.PubMedGoogle Scholar
  12. 12.
    Ramlakan RJS, Govender S. Sacroiliac joint tuberculosis. Int Orthop. 2007;31(1):121–4.CrossRefPubMedGoogle Scholar
  13. 13.
    Zimmerli W. Clinical practice. Vertebral osteomyelitis. N Engl J Med. 2010;362(11):1022–9.CrossRefPubMedGoogle Scholar
  14. 14.
    An HS, Seldomridge JA. Spinal infections: diagnostic tests and imaging studies. Clin Orthop. 2006;444:27–33.CrossRefPubMedGoogle Scholar
  15. 15.
    Rankine JJ, Barron DA, Robinson P, Millner PA, Dickson RA. Therapeutic impact of percutaneous spinal biopsy in spinal infection. Postgrad Med J. 2004;80(948):607–9.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Sehn JK, Gilula LA. Percutaneous needle biopsy in diagnosis and identification of causative organisms in cases of suspected vertebral osteomyelitis. Eur J Radiol. 2012;81(5):940–6.CrossRefPubMedGoogle Scholar
  17. 17.
    Marschall J, Bhavan KP, Olsen MA, Fraser VJ, Wright NM, Warren DK. The impact of prebiopsy antibiotics on pathogen recovery in hematogenous vertebral osteomyelitis. Clin Infect Dis Off Publ Infect Dis Soc Am. 2011;52(7):867–72.CrossRefGoogle Scholar

Copyright information

© ISS 2017

Authors and Affiliations

  • David Knipp
    • 1
  • F. Joseph Simeone
    • 1
  • Sandra B. Nelson
    • 2
  • Ambrose J. Huang
    • 1
  • Connie Y. Chang
    • 1
  1. 1.Division of Musculoskeletal Imaging and Intervention, Department of RadiologyMassachusetts General HospitalBostonUSA
  2. 2.Infectious Disease Unit, Department of MedicineMassachusetts General HospitalBostonUSA

Personalised recommendations