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Diagnosing periprosthetic hip joint infection with new-generation 0.55T MRI
Jan Plesniar1, Hanns-Christian Breit2, Martin Clauss3
1Department of Radiology, University Hospital Basel, Basel, Switzerland; University of Basel, Basel, Switzerland.
Purpose:
To assess the accuracy of 0.55 T MRI in diagnosing periprosthetic joint infection (PJI) in patients with symptomatic total hip arthroplasty (THA).
Material And Methods:
0.55 T MRI of patients with THA PJI (Group A) and noninfected THA (Group B), including aseptic loosening (Group C, subgroup of B) performed between May 2021 and July 2023 were analysed retrospectively. Two musculoskeletal fellowship-trained radiologists independently identified MRI bone and soft tissue changes including: marrow oedema, periosteal reaction, osteolysis, joint effusion, capsule oedema and thickening, fluid collections, muscle oedema, bursitis, inguinal adenopathy, and muscle tears. The diagnostic performance of MRI discriminators of PJI was evaluated using Fisher's exact test (p < 0.05) and interrater reliability was determined. 61 MRI scans from 60 THA patients (34 female, median age 68, range 41-93 years) in Group A (n = 9; female 4; median age 69, range 56-82 years), B (n = 51; 30; 67.5, 41-93 years), and C (10; 6; 67; 41-82 years) were included.
Results:
Capsule oedema (sensitivity 89 %, specificity 92 %,), intramuscular oedema (89 %, 82 %) and joint effusion (89 %, 73 %) were the best performing discriminators for PJI diagnosis (p ≤ 0.001), when viewed individually and had combined 70 % sensitivity and 100 % specificity for PJI diagnosis in parallel testing. For the differentiation between PJI and aseptic loosening, intramuscular oedema (89 %, 80 %) and capsule oedema (89 %, 80 %) were significant discriminators (p ≤ 0.001) with combined 64 % sensitivity and 96 % specificity for PJI.
Conclusions:
New generation 0.55 T MRI may aid in the detection of PJI in symptomatic patients. Oedema of the joint capsule, adjacent muscles as well as joint effusion were indicative of the presence of PJI.
Insights
New 0.55 Tesla MRI effectively detects periprosthetic joint infection (PJI) in symptomatic total hip arthroplasty patients. Key indicators include joint capsule and muscle edema, and joint effusion, aiding accurate PJI diagnosis.
Area of Science:
- Orthopedic Surgery
- Radiology
- Medical Imaging
Background:
- Periprosthetic joint infection (PJI) is a serious complication following total hip arthroplasty (THA).
- Accurate diagnosis of PJI is crucial for effective treatment and patient outcomes.
- Symptomatic THA patients require reliable diagnostic tools to differentiate PJI from other complications like aseptic loosening.
Purpose of the Study:
- To evaluate the diagnostic accuracy of 0.55 Tesla (T) Magnetic Resonance Imaging (MRI) for detecting PJI in patients with symptomatic THA.
- To identify specific MRI findings indicative of PJI in the context of THA.
Main Methods:
- Retrospective analysis of 61 MRI scans (May 2021-July 2023) from patients with THA, including those with PJI, noninfected THA, and aseptic loosening.
- Two musculoskeletal radiologists independently assessed bone and soft tissue changes on 0.55T MRI.
- Statistical analysis using Fisher's exact test to determine the diagnostic performance of MRI findings for PJI.
Main Results:
- Capsular edema (89% sensitivity, 92% specificity), intramuscular edema (89% sensitivity, 82% specificity), and joint effusion (89% sensitivity, 73% specificity) were significant indicators of PJI.
- Combined assessment of these findings showed 70% sensitivity and 100% specificity for PJI.
- For differentiating PJI from aseptic loosening, intramuscular and capsular edema demonstrated 89% sensitivity and 80% specificity, with a combined 64% sensitivity and 96% specificity for PJI.
Conclusions:
- New generation 0.55T MRI shows promise in aiding the detection of PJI in symptomatic THA patients.
- Edema of the joint capsule and adjacent muscles, along with joint effusion, are key MRI findings suggestive of PJI.
- 0.55T MRI can assist in differentiating PJI from aseptic loosening in THA.
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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...