TY - JOUR
T1 - Failed Total Hip Arthroplasty
T2 - Diagnostic Performance of Conventional MRI Features and Locoregional Lymphadenopathy to Identify Infected Implants
AU - Albano, Domenico
AU - Messina, Carmelo
AU - Zagra, Luigi
AU - Andreata, Mauro
AU - De Vecchi, Elena
AU - Gitto, Salvatore
AU - Sconfienza, Luca M.
N1 - Publisher Copyright:
© 2020 International Society for Magnetic Resonance in Medicine
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2021
Y1 - 2021
N2 - Background: Very little has been published about the diagnostic performance of MRI in total hip arthroplasty (THA) infection. Purpose: To determine the diagnostic performance of conventional MRI features and of new lymph nodal indices to identify infection in patients with failed THA. Study Type: Retrospective. Population: In all, 119 patients (66 females; age 66.9 ± 12.4 years) with failed THA. Field Strength/Sequences: Metal artifact reduction sequence (MARS) protocol including short tau inversion recovery and turbo spin-echo T1- and T2-weighted sequences at 1.5T. Assessment: Patients underwent pelvis MRI prior to failed THA revision. MRIs were reviewed to identify periprosthetic bone destruction, soft-tissue mass, effusion, synovitis, lamellated synovitis, extracapsular edema, fibrous periprosthetic membrane, bone edema, and extracapsular collection/sinus tract. The number and maximum diameter of inguinal, obturator and iliac lymph nodes of the affected hip were assessed and normalized to those of the unaffected hip to calculate the ratio of nodal size (RNS), ratio of node number (RNN), difference of nodal size (DNS), and difference of node number (DNN). Statistical Tests: The Mann–Whitney U-and chi-square test were used. Diagnostic performance of indices and odds ratios (OR) were calculated. Results: RNS, RNN, DNS, and DNN indices were significantly different (P = 0.000) between infected and noninfected THA, with accuracies ranging from 84.8% (RNS) and 93.1% (RNN). All other MRI features were significantly more prevalent in infected THA (P ≤ 0.002), except bone destruction, periarticular soft-tissue mass, and fibrous membrane (P ≥ 0.031). Sensitivities ranged from 7.9% (soft-tissue mass) to 76.3% (effusion/bone edema), specificity from 45.7% (bone destruction) to 97.5% (synovitis/lamellated synovitis), accuracy from 49.6% (bone destruction) to 81.5% (synovitis), OR from 0.261 (soft-tissue mass) to 35.550 (synovitis). Data Conclusion: Conventional MRI features have limited accuracy to differentiate septic and aseptic THA failure. Lymph nodal indices, particularly those related to nodal number, may represent biomarkers of THA infection. Evidence Level: 3. Technical Efficacy Stage: 2.
AB - Background: Very little has been published about the diagnostic performance of MRI in total hip arthroplasty (THA) infection. Purpose: To determine the diagnostic performance of conventional MRI features and of new lymph nodal indices to identify infection in patients with failed THA. Study Type: Retrospective. Population: In all, 119 patients (66 females; age 66.9 ± 12.4 years) with failed THA. Field Strength/Sequences: Metal artifact reduction sequence (MARS) protocol including short tau inversion recovery and turbo spin-echo T1- and T2-weighted sequences at 1.5T. Assessment: Patients underwent pelvis MRI prior to failed THA revision. MRIs were reviewed to identify periprosthetic bone destruction, soft-tissue mass, effusion, synovitis, lamellated synovitis, extracapsular edema, fibrous periprosthetic membrane, bone edema, and extracapsular collection/sinus tract. The number and maximum diameter of inguinal, obturator and iliac lymph nodes of the affected hip were assessed and normalized to those of the unaffected hip to calculate the ratio of nodal size (RNS), ratio of node number (RNN), difference of nodal size (DNS), and difference of node number (DNN). Statistical Tests: The Mann–Whitney U-and chi-square test were used. Diagnostic performance of indices and odds ratios (OR) were calculated. Results: RNS, RNN, DNS, and DNN indices were significantly different (P = 0.000) between infected and noninfected THA, with accuracies ranging from 84.8% (RNS) and 93.1% (RNN). All other MRI features were significantly more prevalent in infected THA (P ≤ 0.002), except bone destruction, periarticular soft-tissue mass, and fibrous membrane (P ≥ 0.031). Sensitivities ranged from 7.9% (soft-tissue mass) to 76.3% (effusion/bone edema), specificity from 45.7% (bone destruction) to 97.5% (synovitis/lamellated synovitis), accuracy from 49.6% (bone destruction) to 81.5% (synovitis), OR from 0.261 (soft-tissue mass) to 35.550 (synovitis). Data Conclusion: Conventional MRI features have limited accuracy to differentiate septic and aseptic THA failure. Lymph nodal indices, particularly those related to nodal number, may represent biomarkers of THA infection. Evidence Level: 3. Technical Efficacy Stage: 2.
KW - arthroplasty
KW - hip
KW - infections
KW - lymph nodes
KW - magnetic resonance imaging
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U2 - 10.1002/jmri.27314
DO - 10.1002/jmri.27314
M3 - Article
AN - SCOPUS:85089733806
VL - 53
SP - 201
EP - 210
JO - Journal of Magnetic Resonance Imaging
JF - Journal of Magnetic Resonance Imaging
SN - 1053-1807
IS - 1
ER -