Metal-artefact-reduction MRI for diagnosing periprosthetic joint infection: a systematic review and meta-analysis
Ben Thompson1, Jonathan Gibson1, Tanwen Bird1
1College of Medicine and Dental Sciences, University of Birmingham, Birmingham, UK.
Background:
Periprosthetic joint infection (PJI) remains one of the most serious. Advances in metal-artefact-reduction sequences (MARS) now allow for improved diagnostic quality imaging in the periprosthetic region. Early studies suggest the diagnostic efficacy of MARS, including subfeatures, yet no formal synthesis of available data exists.
Methods:
A systematic review and meta-analysis were conducted following PRISMA-DTA and PRISMA 2020 guidelines. Eligible studies include diagnostic accuracy studies reporting MARS-MRI compared with established reference standards, such as Musculoskeletal Infection Society (MSIS) or International Consensus Meeting (ICM) criteria, or intraoperative microbiology and histology. Adults (≥18 years) with hip, knee, or shoulder arthroplasty undergoing MRI for suspected infection or aseptic loosening were included. Comprehensive searches were conducted in PubMed, Embase, Scopus, and Web of Science, from 2005 onwards, without language restriction.
Results:
A total of 11 studies were included in this meta-analysis evaluating MARS-MRI for diagnosing periprosthetic joint infection (PJI). Pooled performance demonstrated high diagnostic accuracy with sensitivity 0.88 (95% CI 0.72-0.95), specificity 0.95 (95% CI 0.80-0.99), and AUC 0.94. Subgroup analysis showed soft tissue changes had the best diagnostic performance (sensitivity 0.82, specificity 0.91), followed by synovitis and effusion, whilst bone changes were less accurate. Overall, MARS-MRI demonstrates excellent utility in diagnosing PJI.
Conclusion:
MARS-MRI demonstrates high diagnostic accuracy for periprosthetic joint infection (sensitivity 0.88, specificity 0.95, AUC 0.94), particularly with soft tissue changes. It aids antimicrobial stewardship by reducing unnecessary interventions. Further large, multi-centre prospective studies are needed to strengthen evidence and validate clinical utility.
Insights
Metal-artefact-reduction sequence MRI (MARS-MRI) shows high accuracy in diagnosing periprosthetic joint infection (PJI). This imaging technique, particularly effective with soft tissue changes, aids in reducing unnecessary interventions for PJI.
Area of Science:
- Orthopedics
- Radiology
- Infectious Diseases
Background:
- Periprosthetic joint infection (PJI) is a serious complication of joint replacement surgery.
- Metal-artefact-reduction sequences (MARS) MRI offers improved imaging quality in the challenging periprosthetic environment.
- Existing studies suggest MARS-MRI's diagnostic potential, but a comprehensive synthesis is lacking.
Purpose of the Study:
- To systematically review and meta-analyze the diagnostic accuracy of MARS-MRI for PJI.
- To evaluate the performance of MARS-MRI in detecting PJI using established reference standards.
Main Methods:
- Systematic review and meta-analysis adhering to PRISMA-DTA and PRISMA 2020 guidelines.
- Inclusion of 11 diagnostic accuracy studies comparing MARS-MRI with reference standards (MSIS/ICM criteria, microbiology, histology).
- Searches conducted in major databases (PubMed, Embase, Scopus, Web of Science) from 2005 onwards without language restrictions.
Main Results:
- MARS-MRI demonstrated high pooled diagnostic accuracy for PJI: sensitivity 0.88, specificity 0.95, AUC 0.94.
- Subgroup analysis indicated soft tissue changes (sensitivity 0.82, specificity 0.91) were the most accurate indicators.
- Synovitis and effusion also showed good performance, while bone changes were less accurate.
Conclusions:
- MARS-MRI is a highly accurate tool for diagnosing PJI, especially when evaluating soft tissue changes.
- The technique supports antimicrobial stewardship by enabling more precise treatment decisions.
- Further large-scale, multi-center prospective studies are recommended to confirm clinical utility.
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