Diagnosis of Periprosthetic Hip Joint Infection Using MRI with Metal Artifact Reduction at 1.5 T
Julien Galley1, Reto Sutter1, Christoph Stern1
1From the Departments of Radiology (J.G., R.S., C.S., L.F., C.W.A.P.) and Orthopedic Surgery (S.R.), Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zürich, Switzerland; and Department of Radiology, HFR, University of Fribourg, Fribourg, Switzerland (J.G.).
Abstract:
Background MRI with metal artifact reduction has gained importance in assessment of pain with total hip arthroplasty (THA). However, its role in diagnosis of periprosthetic joint infection (PJI) has not been well defined. Purpose To evaluate findings of PJI after THA and to determine the diagnostic performance of 1.5-T MRI with metal artifact reduction. Materials and Methods Dedicated compressed sensing-based slice encoding for metal artifact correction 1.5-T MRI examinations (from January 2015 to April 2018) in patients with THA PJI (infection group) and noninfected THA (control group) were retrospectively evaluated by two musculoskeletal radiologists. Fisher exact test was used to compare the groups. Sensitivity, specificity, and accuracy were evaluated for each finding. Interobserver reliability was assessed with κ statistics. Results Forty patients (mean age, 69 years ± 11 [standard deviation]; 26 men) in the infection group and 100 patients (mean age, 67 years ± 11; 42 men) in the control group were evaluated. Periosteal reaction, capsule edema, and intramuscular edema differed between the two groups (P < .001 for each finding). Periosteal reaction was found in 31 of 40 patients with infection and 10 of 100 participants in the control group (sensitivity, 78%; specificity, 90%; accuracy, 86%); capsule edema was found in 33 of 40 (infection group) and five of 100 (control group) (sensitivity, 83%; specificity, 95%; accuracy, 91%); and intramuscular edema was found in 38 of 40 (infection group) and 14 of 100 (control group) (sensitivity, 95%; specificity, 86%; accuracy, 89%). Interobserver agreement was almost perfect, with κ values between 0.88 and 0.92. No difference between the two groups was found regarding the presence of osteolysis (infection group, 23 of 40; control group, 60 of 100), bone marrow edema (39 of 40 vs 87 of 100), effusion (20 of 40 vs 26 of 100), abductor tendon lesion (22 of 40 vs 62 of 100), or bursitis (14 of 40 vs 34 of 100) (P > .05 for each finding). Conclusion The presence of periosteal reaction, capsule edema, and intramuscular edema after total hip arthroplasty at 1.5-T MRI with metal artifact reduction had a high accuracy in evaluation of periprosthetic joint infection. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Zanetti in this issue.
Insights
Metal artifact reduction MRI effectively diagnoses periprosthetic joint infection (PJI) after total hip arthroplasty (THA). Key MRI findings like periosteal reaction, capsule edema, and intramuscular edema show high accuracy in identifying infection.
Area of Science:
- Radiology
- Orthopedic Surgery
- Infectious Disease
Background:
- Magnetic Resonance Imaging (MRI) with metal artifact reduction is increasingly used for assessing pain in total hip arthroplasty (THA).
- The diagnostic utility of this MRI technique for periprosthetic joint infection (PJI) after THA remains underexplored.
Purpose of the Study:
- To evaluate specific MRI findings indicative of PJI in patients with THA.
- To determine the diagnostic performance of 1.5-T MRI with metal artifact reduction for PJI detection.
Main Methods:
- Retrospective evaluation of 1.5-T MRI scans using compressed sensing-based slice encoding for metal artifact correction.
- Two musculoskeletal radiologists assessed MRI examinations from patients with THA PJI (infection group) and non-infected THA (control group).
- Statistical analysis included Fisher exact test for group comparison and κ statistics for interobserver reliability.
Main Results:
- Periosteal reaction, capsule edema, and intramuscular edema were significantly different between infection and control groups (P < .001).
- High diagnostic accuracy was observed for these findings: periosteal reaction (86%), capsule edema (91%), and intramuscular edema (89%).
- Interobserver agreement was excellent (κ values 0.88–0.92); osteolysis, bone marrow edema, effusion, tendon lesions, and bursitis showed no significant difference.
Conclusions:
- 1.5-T MRI with metal artifact reduction demonstrates high accuracy in diagnosing PJI after THA.
- Periosteal reaction, capsule edema, and intramuscular edema are key indicators of PJI in this context.
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