1.5T 磁共振金属伪影校正技术在人工髋关节置换术后感染诊断中的应用
Diagnosis of Periprosthetic Hip Joint Infection Using MRI with Metal Artifact Reduction at 1.5 T.
机构信息
From the Departments of Radiology (J.G., R.S., C.S., L.F., C.W.A.P.) and Orthopedic Surgery (S.R.), Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zürich, Switzerland; and Department of Radiology, HFR, University of Fribourg, Fribourg, Switzerland (J.G.).
出版信息
Radiology. 2020 Jul;296(1):98-108. doi: 10.1148/radiol.2020191901. Epub 2020 May 12.
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 κ 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 ( < .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 κ 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) ( > .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 See also the editorial by Zanetti in this issue.
背景 带有金属伪影减少功能的磁共振成像（MRI）在全髋关节置换术（THA）后疼痛评估中变得越来越重要。然而，其在诊断假体周围关节感染（PJI）中的作用尚未得到很好的定义。目的 评估 THA 后 PJI 的影像学表现，并确定具有金属伪影减少功能的 1.5-T MRI 的诊断性能。材料与方法 对 2015 年 1 月至 2018 年 4 月间因 THA PJI（感染组）和非感染性 THA（对照组）接受专用基于压缩感知的金属伪影校正片层编码 1.5-T MRI 检查的患者进行回顾性分析。两名肌肉骨骼放射科医生对这些检查结果进行了评估。采用 Fisher 确切检验比较两组之间的差异。评估了每种表现的敏感性、特异性和准确性。采用 κ 统计量评估观察者间的可靠性。结果 在感染组中，40 名患者（平均年龄 69 岁±11 岁[标准差]；26 名男性）和对照组 100 名患者（平均年龄 67 岁±11 岁；42 名男性）接受了评估。两组之间的骨膜反应、关节囊水肿和肌内水肿存在差异（每种表现均<.001）。31 例感染患者和 10 例对照组患者存在骨膜反应（敏感性 78%；特异性 90%；准确性 86%）；33 例感染患者和 5 例对照组患者存在关节囊水肿（敏感性 83%；特异性 95%；准确性 91%）；38 例感染患者和 14 例对照组患者存在肌内水肿（敏感性 95%；特异性 86%；准确性 89%）。观察者间的一致性几乎为完美，κ 值在 0.88 至 0.92 之间。两组之间在骨溶解（感染组 23 例，对照组 60 例）、骨髓水肿（感染组 39 例，对照组 87 例）、关节积液（感染组 20 例，对照组 26 例）、外展肌腱病变（感染组 22 例，对照组 62 例）或滑囊炎（感染组 14 例，对照组 34 例）的存在方面无差异（每种表现均>.05）。结论 在 1.5-T MRI 上使用金属伪影减少技术后，全髋关节置换术后出现骨膜反应、关节囊水肿和肌内水肿，对假体周围关节感染的评估具有较高的准确性。
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