Diagnosis of Periprosthetic Hip Joint Infection Using MRI with Metal Artifact Reduction at 1.5 T

Abstract

Background MRI with metal artifact reduction has gained importance in assessment of pain with total hip arthroplasty (THA). However, its role in diagnosis of periprosthetic joint infection (PJI) has not been well defined. Purpose To evaluate findings of PJI after THA and to determine the diagnostic performance of 1.5-T MRI with metal artifact reduction. Materials and Methods Dedicated compressed sensing-based slice encoding for metal artifact correction 1.5-T MRI examinations (from January 2015 to April 2018) in patients with THA PJI (infection group) and noninfected THA (control group) were retrospectively evaluated by two musculoskeletal radiologists. Fisher exact test was used to compare the groups. Sensitivity, specificity, and accuracy were evaluated for each finding. Interobserver reliability was assessed with statistics. Results Forty patients (mean age, 69 years ± 11 [standard deviation]; 26 men) in the infection group and 100 patients (mean age, 67 years ± 11; 42 men) in the control group were evaluated. Periosteal reaction, capsule edema, and intramuscular edema differed between the two groups (P < .001 for each finding). Periosteal reaction was found in 31 of 40 patients with infection and 10 of 100 participants in the control group (sensitivity, 78%; specificity, 90%; accuracy, 86%); capsule edema was found in 33 of 40 (infection group) and five of 100 (control group) (sensitivity, 83%; specificity, 95%; accuracy, 91%); and intramuscular edema was found in 38 of 40 (infection group) and 14 of 100 (control group) (sensitivity, 95%; specificity, 86%; accuracy, 89%). Interobserver agreement was almost perfect, with values between 0.88 and 0.92. No difference between the two groups was found regarding the presence of osteolysis (infection group, 23 of 40; control group, 60 of 100), bone marrow edema (39 of 40 vs 87 of 100), effusion (20 of 40 vs 26 of 100), abductor tendon lesion (22 of 40 vs 62 of 100), or bursitis (14 of 40 vs 34 of 100) (P > .05 for each finding). Conclusion The presence of periosteal reaction, capsule edema, and intramuscular edema after total hip arthroplasty at 1.5-T MRI with metal artifact reduction had a high accuracy in evaluation of periprosthetic joint infection. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Zanetti in this issue.

Prospective and longitudinal evolution of postoperative periprosthetic findings on metal artifact–reduced MR imaging in asymptomatic patients after uncemented total hip arthroplasty

“…BME after THA may occur due not only to intraoperative reaming and compaction techniques but also from pathologic conditions such as mechanical stress reaction, implant loosening, or infection [13,22,24,32,33]. Compared to a retrospective cross-sectional study [24], our prospective study gives incremental insight regarding the evolution of BME over time.…”

“…Being the most accurate imaging modality to evaluate periprosthetic soft tissues, metal artifact-reduced MRI is of paramount importance to assess local complications after THA [2,[8][9][10][11][12][13]. Recently developed metal artifact reduction techniques such as Slice Encoding for Metal Artifact Correction (SEMAC) improve the detection of complications after THA [14][15][16][17][18] and advanced reconstruction techniques such as Compressed Sensing for SEMAC (CS-SEMAC) allow reducing the formerly long acquisition times [7,19,20].…”

The Role of Imaging Techniques to Define a Peri-Prosthetic Hip and Knee Joint Infection: Multidisciplinary Consensus Statements

“…For knee arthroplasty, MRI has been shown to be highly sensitive (92%) and specific (99%) for diagnosing PJI. Only one paper has been published in patients with hip arthroplasty showing that the presence of periosteal reaction, capsule edema, and intramuscular edema has a high accuracy for evaluating PJI [ 23 ], ( Figure 2 ). Similar to US, MRI has the advantage of not using ionizing radiation or contrast agents [ 24 , 25 , 26 ].…”

“…The general advantages of MRI compared to CT include a better evaluation of soft tissue and a lack of radiation burden. In addition, MRI sequences that avoid artefacts from metallic implants are now widely available [ 23 , 24 , 25 , 26 , 47 , 48 , 49 , 50 , 51 ].…”

“…In knee implants, the sensitivity and specificity of MRI in diagnosing PJI range from 65% to 92% and 85% to 99%, respectively [ 14 ]. Similarly, in the hip, the presence of periosteal reaction, capsule edema, and intramuscular edema demonstrated a sensitivity ranging from 78% to 95% and a specificity from 86% to 97%, depending on the signs that are considered for the diagnosis [ 23 , 50 ]. MRI also has the great advantage of not using ionizing radiation or contrast agents [ 24 , 25 , 26 ].…”