The Utility of MRI With Multiacquisition Variable-Resonance Image Combination (MAVRIC) in Diagnosing Deep Total Hip
Ashley E Levack1, Chelsea Koch1, Harold G Moore2
1Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA.
Abstract:
Background: The 2010 American Academy of Orthopaedic Surgeons Clinical Practice Guidelines report insufficient evidence to address the diagnostic efficacy of magnetic resonance imaging (MRI) for periprosthetic joint infection (PJI). Questions/Purposes: The purpose of this study was to determine the utility of MRI with multiacquisition variable-resonance image combination (MAVRIC) metal artifact suppression techniques in diagnosing PJI in the setting of total hip arthroplasty (THA). Methods: Multiacquisition variable-resonance image combination MRIs obtained of THAs between November 2012 and November 2016 were queried. Radiology reports were classified as positive (suspicious for infection), negative (no features of infection), or inconclusive (infection cannot be excluded or correlation with aspiration suggested if clinically concerned). Chart review identified cases of deep PJI according to the modified Musculoskeletal Infection Society criteria. Results: Of 2156 MRIs of THAs included, MRI was concerning for infection in 1.8% (n = 39), inconclusive in 1.2% (n = 26), and negative in 97.0% (n = 2091). Deep PJI was identified in 53 (2.5%) patients, 30 of whom (56.6%) had conclusively positive finding on MRI (false-negative rate: 43.4%, sensitivity: 56.6%). Of 2103 aseptic THAs, only 9 (0.4%) MRIs were read as suspicious for infection (false-positive rate: 0.4%; specificity: 99.6%). Conclusion: Magnetic resonance imaging with MAVRIC is a highly specific test for PJI with a low false-positive rate. This indicates that when clinicians are provided with an MRI that unexpectedly suggests infection, a formal evaluation for infection is indicated. In patients with otherwise equivocal diagnostic findings, MRI may help confirm, but not refute, a diagnosis of PJI. Prospective study with more experienced image reviewers may further support the use of MRI in PJI.
Insights
Magnetic resonance imaging (MRI) with MAVRIC is highly specific for diagnosing periprosthetic joint infection (PJI) after total hip arthroplasty. While not fully ruling out infection, it aids in confirming PJI when other tests are unclear.
Area of Science:
- Orthopedic Surgery
- Radiology
- Infectious Disease
Background:
- Previous guidelines found insufficient evidence for MRI's diagnostic efficacy in periprosthetic joint infection (PJI).
- The need for improved diagnostic tools for PJI in total hip arthroplasty (THA) remains critical.
Purpose of the Study:
- To evaluate the diagnostic utility of multiacquisition variable-resonance image combination (MAVRIC) MRI in identifying PJI following THA.
- To assess the accuracy of MAVRIC MRI, including its sensitivity and specificity, in detecting deep PJI.
Main Methods:
- Retrospective review of MAVRIC MRI scans performed on THAs between November 2012 and November 2016.
- Radiology reports were categorized as positive, negative, or inconclusive for infection.
- Patient charts were reviewed to confirm deep PJI using modified Musculoskeletal Infection Society criteria.
Main Results:
- Of 2156 MRIs, 1.8% were concerning for infection and 1.2% were inconclusive.
- Deep PJI was confirmed in 53 patients; MAVRIC MRI showed positive findings in 56.6% (sensitivity 56.6%, false-negative rate 43.4%).
- The specificity for aseptic THAs was high at 99.6% (false-positive rate 0.4%).
Conclusions:
- MAVRIC MRI is a highly specific tool for diagnosing PJI, with a low false-positive rate.
- An MRI suggesting infection warrants a formal evaluation for PJI.
- MAVRIC MRI can help confirm PJI in cases with equivocal findings but cannot definitively refute the diagnosis.
More Related Videos
07:15In vivo Macrophage Imaging Using MR Targeted Contrast Agent for Longitudinal Evaluation of Septic Arthritis
Published on: October 20, 2013
18:40Combined In vivo Optical and µCT Imaging to Monitor Infection, Inflammation, and Bone Anatomy in an Orthopaedic Implant Infection in Mice
Published on: October 16, 2014
Related Concept Videos
01:24Magnetic Resonance Imaging
01:30Radiological Investigation II: MRI and Ventilation Perfusion Scan
Magnetic Resonance Imaging (MRI) and Ventilation Perfusion Scans are two radiological investigations that offer detailed diagnostic images of the body, particularly lung structures.
MRI
MRI uses magnetic fields and radiofrequency signals to distinguish between normal and abnormal tissues. This technology provides a more detailed diagnostic image than CT scans, enabling it to characterize pulmonary nodules, stage bronchogenic carcinoma, and evaluate inflammatory activity in...
01:21Imaging Studies for Cardiovascular System IV: CMRI
01:27Imaging Studies IV: Magnetic Resonance Imaging
01:14Imaging Studies I: CT and MRI
Description of the Procedures
Computed Tomography (CT) scan:
Computed Tomography (CT) scans use X-ray technology to generate detailed images of bones, organs, and tissues. During the scan, the patient lies on a moving table...
01:27Imaging Studies III: Computed Tomography