Detection of musculoskeletal inflammatory lesions in patients with chronic chikungunya infection using 3T whole-body magnetic resonance imaging

Abstract

Background: Musculoskeletal inflammatory lesions in chronic Chikungunya virus (CHIKV) infection have not been thoroughly assessed using whole-body magnetic resonance imaging (WBMRI). This study aimed to determine the prevalence of these lesions in such patients.

Methods: From September 2018 to February 2019, patients with positive Chikungunya-specific serology (Immunoglobulin M/Immunoglobulin G anti-CHIKV), with a history of polyarthralgia for > 6 months prior to MRI with no pre-existing rheumatic disorders, underwent 3T WBMRI and localized MRI. The evaluation focused on musculoskeletal inflammatory lesions correlated with chronic CHIKV infection. Pain levels were assessed using a visual analogue scale on the same day as WBMRI.

Results: The study included 86 patients of whom 26 met the inclusion criteria. All patients reported pain and most (92.3%) categorized it as moderate or severe. The most common finding across joints was effusion, particularly in the tibiotalar joint (57.7%) and bursitis, with the retrocalcaneal bursa most affected (48.0%). Tenosynovitis was prevalent in the flexor compartment of the hands (44.2%), while Kager fat pad and soleus edema were also observed. Bone marrow edema-like signals were frequently seen in the sacroiliac joints (19.2%). Most WBMRI findings were classified as mild.

Conclusions: This study represents the first utilization of 3T WBMRI to assess musculoskeletal inflammatory disorders in chronic CHIKV infection. The aim was to identify the most affected joints and prevalent lesions, providing valuable insights for future research and clinical management of this condition regarding understanding disease pathophysiology, developing targeted treatment strategies, and using advanced imaging techniques in the assessment of musculoskeletal manifestations.

FIGURE 1:. WBMRI protocol with T1 (A) and STIR (B) weighted images of the whole-body in coronal plane.

FIGURE 2:. A. 61-year-old female with severe pain in the knee and ankles for 7 months with use of steroids and methotrexate. Sagittal STIR depicts joint effusion in the posterior subtalar joint (white arrow) and Kager fat pad edema (black arrow). B. 38-year-old female with pain in shoulders, hands, legs and feet for one year, with use of steroids and methotrexate. Sagittal STIR shows retrocalcaneal bursitis (black arrow).

FIGURE 3:. 61-year-old female with pain in hands and feet for one year with use of nonsteroidal anti-inflammatory drugs. Axial T2 fat-suppressed weighted image of the right hand and coronal STIR of the hands show tenosynovitis of the flexor tendon of the fifth finger.

FIGURE 4:. 49-year-old female with pain in arms, hands, ankles and feet for a year, in treatment with steroids. Coronal (A) and sagittal (B) STIR of the ankles depicts edema in the distal portion of the soleus (arrows).

FIGURE 5:. 64-year-old female with severe pain in wrists, hands and ankles for two years. Current with no treatment. Coronal STIR (A), coronal PD-weighted (B) and T1-weighted (C) images depict bilateral bone marrow edema of the carpal bones (white arrows) and erosions (black arrows).