磁共振成像作为分析疑难膝关节置换术问题的诊断方式：一项系统评价
MRI as Diagnostic Modality for Analyzing the Problematic Knee Arthroplasty: A Systematic Review.
作者信息
Schröder Femke F, Post Corine E, Wagenaar Frank-Christiaan B M, Verdonschot Nico, Huis In't Veld Rianne M H A
机构信息
The OCON, Centre for Orthopaedic Surgery, Hengelo, The Netherlands.
University of Twente, Faculty of Engineering Technology, Biomechanical Engineering, The Netherlands.
出版信息
J Magn Reson Imaging. 2020 Feb;51(2):446-458. doi: 10.1002/jmri.26874. Epub 2019 Jul 22.
BACKGROUND
Various diagnostic modalities are available to assess the problematic knee arthroplasty. Visualization of soft-tissue structures in relation to the arthroplasty and bone remains difficult. Recent developments in MRI sequences could make MRI a viable addition to the diagnostic arsenal.
PURPOSE
To review the diagnostic properties of MRI, to identify certain causes of complaints that may be directly related to implant failure of total (TKA) or unicompartmental knee arthroplasty (UKA); infection, loosening and wear, instability, malalignment, arthrofibrosis, or patellofemoral problems.
STUDY TYPE
Systematic review.
POPULATION
Twenty-three studies were included: 16 TKA, four UKA, and three cadaveric studies. Causes of knee arthroplasty complaints analyzed were; infection (three), loosening and wear (11), malalignment (five) and instability (four).
FIELD STRENGTH AND SEQUENCES
No field strength or sequence restrictions.
ASSESSMENT
PubMed, SCOPUS, and EMBASE were searched. Risk of bias was assessed using the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) and the QUality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2).
STATISTICAL TESTS
The results of the original research articles are stated.
RESULTS
Fifteen studies assessed the reproducibility of analyzing infection, loosening and wear, and malalignment. Fourteen of 15 studies were deemed as adequate to good quality. Results showed a moderate to excellent agreement (ICC/K 0.55-0.97). Fourteen studies addressed the accuracy. For infection and loosening and wear the sensitivity and specificity estimates varied between 0.85-0.97 and 0.70-1.00, respectively. The accuracy for malalignment was excellent (r ≥ 0.81). For these studies QUADAS-2 analysis suggested few risks of bias. A meta-analysis was not possible due to the heterogeneity of the data.
DATA CONCLUSION
This study supports that MRI can be used with overall reproducible and accurate results for diagnosing infection, loosening and wear, and malalignment after knee arthroplasty. Nonetheless, studies regarding the diagnosis of instability, arthrofibrosis or patellofemoral complaints using MRI are limited and inconclusive.
LEVEL OF EVIDENCE
3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2020;51:446-458.
背景
有多种诊断方法可用于评估有问题的膝关节置换术。要清晰显示与关节置换术及骨骼相关的软组织结构仍然困难。磁共振成像（MRI）序列的最新进展可能使MRI成为诊断手段中的一个可行补充。
目的
回顾MRI的诊断特性，确定可能与全膝关节置换术（TKA）或单髁膝关节置换术（UKA）的植入物失败直接相关的某些投诉原因；感染、松动和磨损、不稳定、排列不齐、关节纤维化或髌股问题。
研究类型
系统评价。
研究对象
纳入23项研究：16项TKA研究、4项UKA研究和3项尸体研究。分析的膝关节置换术投诉原因包括：感染（3项）、松动和磨损（11项）、排列不齐（5项）和不稳定（4项）。
场强和序列
无场强或序列限制。
评估
检索了PubMed、SCOPUS和EMBASE。使用基于共识的健康测量工具选择标准（COSMIN）和诊断准确性研究质量评估-2（QUADAS-2）评估偏倚风险。
统计检验
陈述了原始研究文章的结果。
结果
15项研究评估了分析感染、松动和磨损以及排列不齐的可重复性。15项研究中的14项被认为质量良好。结果显示一致性为中等至优秀（组内相关系数/卡帕值为0.55 - 0.97）。14项研究探讨了准确性。对于感染和松动及磨损，敏感性和特异性估计值分别在0.85 - 0.97和0.70 - 1.00之间。排列不齐的准确性极佳（r≥0.81）。对于这些研究QUADAS-2分析表明偏倚风险较小。由于数据的异质性，无法进行荟萃分析。
数据结论
本研究支持MRI可用于诊断膝关节置换术后感染、松动和磨损以及排列不齐，结果具有总体可重复性和准确性。尽管如此，但关于使用MRI诊断不稳定、关节纤维化或髌股问题的研究有限且尚无定论。
证据水平
3 技术疗效：2期 《磁共振成像杂志》2020年；51:446 - 458
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