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Diagnostic value of magnetic resonance imaging for patients with periprosthetic joint infection: a systematic review
Chang Shufen1,2, Liu Jinmin1, Zhang Xiaohui1,2
1Department of Orthopaedics, Lanzhou University Second Hospital, 730000, Lanzhou, Gansu, China.
Purpose:
The purpose of this study was to provide a critical systematic review of the role of magnetic resonance imaging (MRI) as a noninvasive method to assess periprosthetic joint infections (PJIs).
Methods:
The electronic databases PubMed and EMBASE were searched, since their inception up to March 27, 2022. The included studies evaluated the reproducibility and accuracy of MRI features to diagnose PJIs. The article quality assessment was conducted by the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) and Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2).
Results:
Among 1909 studies identified in the initial search, 8 studies were eligible for final systematic review. The included studies evaluated the reproducibility and accuracy of MRI features to diagnose PJIs. Seven of 8 studies showed good to excellent reliability, but only one article among them in which accuracy was evaluated had a low risk of bias. The intraclass correlation coefficient (ICC) and Cohen coefficient (κ) varied between 0.44 and 1.00. The accuracy varied between 63.9% and 94.4%. Potential MRI features, such as lamellated hyperintense synovitis, edema, fluid collection, or lymphadenopathy, might be valuable for diagnosing PJIs.
Conclusion:
The quality of the evidence regarding the role of MRI for PJIs diagnosis was low. There is preliminary evidence that MRI has a noteworthy value of distinguishing suspected periprosthetic joint infection in patients with total knee arthroplasty or total hip arthroplasty, but the definition of specific MRI features related to PJIs diagnosis lacks consensus and standardization. Large-scale studies with robust quality were required to help make better clinical decisions in the future.
Insights
Magnetic resonance imaging (MRI) shows promise for diagnosing periprosthetic joint infections (PJIs), but evidence quality is low. Further large-scale studies are needed to standardize MRI features for reliable PJI diagnosis.
Area of Science:
- Medical Imaging
- Orthopedic Surgery
- Infectious Diseases
Background:
- Periprosthetic joint infections (PJIs) are serious complications following arthroplasty.
- Accurate and noninvasive diagnostic methods are crucial for timely PJI management.
- Magnetic resonance imaging (MRI) is a potential noninvasive tool for PJI assessment.
Conclusions:
- The overall quality of evidence for MRI in PJI diagnosis is low.
- Preliminary evidence suggests MRI's value in diagnosing PJIs in knee and hip arthroplasty.
- Lack of consensus on specific MRI features and need for large-scale, high-quality studies for clinical decision-making.
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