Department of Radiology, Faculty of Medicine, Universidade Federal Do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
Medscanlagos Radiology, rua Manoel Francisco Valentim, 57, Cabo Frio, RJ, 28906220, Brazil.
Skeletal Radiol. 2022 Oct;51(10):1947-1958. doi: 10.1007/s00256-022-04046-0. Epub 2022 Mar 31.
To determine the rate of infection in patients with suspected hip septic arthritis who underwent image-guided aspiration (IHA) resulting in dry-tap, diagnostic value of subsequent lavage and re-aspiration, and if pre-aspiration MRI can help prevent a dry tap.
Retrospective review between 2010 to 2020 identified native hip (NH) and total hip arthroplasty (THA) patients who had a dry-tap following aspiration for suspected infection or periprosthetic joint infection (PJI). Serology tests, lavage/re-aspiration volumes, and aspirate cell-count/culture were assessed. On pre-aspiration MRI, presence/grade of joint effusion (JE), pseudocapsule dehiscence (PD), extraarticular fluid and sinus-tract were recorded.
Out of 215 included dry-taps, 185 (86.0%) were non-infected and 30 (13.9%) infected. In subgroup analysis, 64/71(90.1%) NH and 121/144(84.0%) THA dry-taps were non-infected. Pre-aspiration MRI of THA group with dry-tap showed significant findings; PD with extraarticular fluid (8/12, 66.7%) and sinus tract (7/12, 58.3%) were higher in the infected compared to non-infected group (5/42, 11.9% and 0/42, 0.0%) (both p < 0.001). Among THA group, polymorphonuclear-leukocytes > 80% was present in 8/9 (88.9%) of infected versus 4/28 (14.3%) non-infected group (p < 0.001). Multivariable regression showed PD (p = 0.005) and JE (p = 0.042) being significant independent predictors of PJI, similarly the elevated CRP (p = 0.044) and JE (p = 0.017).
Majority of patients suspected of hip joint infection with dry-tap were non-infected. Synovial PMN% following lavage maintains high sensitivity for detection of PJI. In patients with THA, PD and subsequent extraarticular collection can be associated with dry-tap therefore, pre-aspiration MRI can help determine their presence and plan the aspiration.
确定行影像引导下抽吸术（IHA）后出现干抽的疑似髋关节化脓性关节炎患者的感染率，以及后续灌洗和再抽吸的诊断价值，以及在抽吸前行 MRI 是否有助于预防干抽。
回顾 2010 年至 2020 年期间，对接受疑似感染或假体周围关节感染（PJI）抽吸的患者进行了研究，这些患者在抽吸后出现了干抽。评估了血清学检查、灌洗/再抽吸量以及抽吸物细胞计数/培养。在抽吸前的 MRI 上，记录关节积液（JE）、假性囊破裂（PD）、关节外积液和窦道的存在/分级。
在 215 例干抽中，185 例（86.0%）为非感染性，30 例（13.9%）为感染性。在亚组分析中，64/71（90.1%）例 NH 和 121/144（84.0%）例 THA 的干抽为非感染性。THA 组干抽的抽吸前 MRI 显示出显著的发现；PD 合并关节外积液（8/12，66.7%）和窦道（7/12，58.3%）在感染组中高于非感染组（5/42，11.9%和 0/42，0.0%）（均 p<0.001）。在 THA 组中，感染组中 PMN%>80%的有 8/9（88.9%）例，而非感染组中仅有 4/28（14.3%）例（p<0.001）。多变量回归显示，PD（p=0.005）和 JE（p=0.042）是 PJI 的独立预测因子，同样，CRP 升高（p=0.044）和 JE（p=0.017）也是。
大多数疑似髋关节感染性关节炎伴干抽的患者为非感染性。灌洗后的滑膜 PMN%对 PJI 的检测具有高灵敏度。对于 THA 患者，PD 和随后的关节外积液可能与干抽有关，因此，抽吸前 MRI 有助于确定其存在并计划抽吸。
