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Evaluating Hip Periprosthetic Joint Infection with Metal-artifact-reduction MR Imaging
Tsutomu Inaoka1, Masayuki Sugeta1, Tomoya Nakatsuka1
1Department of Radiology, Toho University Sakura Medical Center, Sakura, Chiba, Japan.
Purpose:
To evaluate the significant findings of hip periprosthetic joint infection (PJI) using metal-artifact-reduction (MAR) MRI and to compare the MRI results to other clinical markers.
Methods:
The results of MRI, including two-dimensional fast-spin echo sequences with increased bandwidth and multi-acquisition variable-resonance image combination selective for hips with orthopedic implants at 1.5T (from April 2014 to November 2021), were retrospectively assessed for imaging findings and diagnostic impressions by two radiologists. Clinical data and courses were also investigated. Univariate and multivariate analyses were performed to identify the significant MRI findings in patients with hip PJI and those who underwent surgical intervention. The MRI impressions were compared with other clinical markers in diagnosing hip PJI.
Results:
Thirty-seven hip joints in 24 Asian patients (age = 73.9 ± 10.8 years; 18 females) were included. Twelve hip joints (32%) had PJI; seven underwent a surgical intervention. The significant findings for hip PJI included periosteal edema of the acetabulum, intermuscular edema, intramuscular fluid collection, and lymphadenopathy (P < 0.05). In the cases with surgical intervention, the significant findings included capsular distension, capsular thickening, an osteolysis-like pattern of the femur, subcutaneous fluid collection, and lymphadenopathy (P < 0.05). The MRI impressions had high diagnostic significance for both hip PJI cases and those with surgical intervention (P < 0.001). The MRI impression was more significant for hip PJI than the other clinical markers (P < 0.05), while the other clinical markers were more significant in the cases with surgical intervention (P < 0.05).
Conclusion:
The significant findings in the hip PJI cases included acetabular periosteal edema, intermuscular edema, intramuscular fluid collection, and lymphadenopathy. The significant findings in the cases with surgical intervention included capsular distention, capsular thickening, a femoral osteolysis-like pattern, subcutaneous fluid collection, and lymphadenopathy. The utilization of MAR MRI demonstrated great diagnostic significance for hip PJI.
Insights
Metal-artifact-reduction MRI effectively identifies hip periprosthetic joint infection (PJI) findings like edema and fluid collections. This advanced imaging technique shows high diagnostic significance for hip PJI, outperforming other clinical markers.
Area of Science:
- Orthopedic imaging
- Radiology
- Infectious disease diagnostics
Background:
- Periprosthetic joint infection (PJI) is a serious complication of hip arthroplasty.
- Accurate diagnosis of hip PJI is crucial for effective treatment and patient outcomes.
- Metal artifacts from orthopedic implants can hinder diagnostic imaging accuracy.
Purpose of the Study:
- To evaluate significant findings of hip PJI using metal-artifact-reduction (MAR) MRI.
- To compare the diagnostic performance of MAR MRI with other clinical markers for hip PJI.
- To identify key imaging features indicative of hip PJI on MAR MRI.
Main Methods:
- Retrospective assessment of 1.5T MAR MRI scans (2D fast-spin echo, increased bandwidth) in patients with hip implants.
- Analysis of imaging findings and diagnostic impressions by two radiologists.
- Comparison of MRI results with clinical data and outcomes using univariate and multivariate analyses.
Main Results:
- MAR MRI identified significant findings for hip PJI, including acetabular periosteal edema, intermuscular edema, intramuscular fluid collection, and lymphadenopathy.
- In cases with surgical intervention, findings included capsular distension/thickening, femoral osteolysis-like pattern, subcutaneous fluid collection, and lymphadenopathy.
- MAR MRI demonstrated high diagnostic significance for hip PJI, surpassing other clinical markers in accuracy.
Conclusions:
- Acetabular periosteal edema, intermuscular edema, intramuscular fluid collection, and lymphadenopathy are significant MRI findings for hip PJI.
- Capsular changes, femoral osteolysis-like patterns, subcutaneous fluid, and lymphadenopathy are key indicators in surgically treated cases.
- MAR MRI is a highly valuable tool for diagnosing hip PJI, offering superior diagnostic performance.
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