Zongyan Gao1, Yi Jin1, Xiao Chen1, Zhipeng Dai1, Shuo Qiang1, Shuyuan Guan2, Qiang Li2, Jincheng Huang1, Jia Zheng1. 1. Department of Orthopedics, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, People's Hospital of Henan University, Zhengzhou, China. 2. Department of Medical Imaging, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, People's Hospital of Henan University, Zhengzhou, China.
Abstract
OBJECTIVE: To investigate the correlation between magnetic resonance imaging (MRI) lamellated hyperintense synovitis and periprosthetic infection of hip arthroplasty and estimate its value in the diagnosis of infection after hip replacement. METHODS: A retrospective analysis of 50 patients who underwent MRI from January 2016 to June 2019 after hip replacement was performed. The MRI scanning was performed with a 1.5T clinical imaging unit using SEMAC protocols. A total of 25 patients (cohort 1) showed infected total hip arthroplasty, and 25 patients had non-infected arthroplasty as controls (cohort 2). Two musculoskeletal radiologists, blinded to the clinical diagnosis, reviewed all the images for the presence of lamellated hyperintense synovitis independently. The cases were rereviewed by each reader after 2 weeks. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated using the first reads. The Kappa statistic was used to assess inter-observer and intra-observer reliability. RESULTS: The incidence of lamellated hyperintense synovitis was 76%-88% in the experimental group and 8%-16% in the control group. The sensitivity of lamellated hyperintense synovitis for infection was 0.80-0.88 (95% confidence interval [CI]:0.59 - 0.97), the specificity was 0.84~0.92 (95% CI: 0.64 -0.99), the positive predictive value 0.83-0.92 (95% CI: 0.67 - 0.98), the negative predictive value 0.81 - 0.88 (95% CI: 0.65 - 0.96). The agreement between two readers was substantial (Kappa = 0.76, 95% CI: 0.58 - 0.94, P < 0.05). There were moderate inter-observer agreements for both readers, reader 1 (Kappa = 0.48, 95%CI: 0.23 - 0.72, P < 0.05) and reader 2 (Kappa = 0.44，95% CI: 0.19 - 0.69, P < 0.05). CONCLUSION: In this cohort, the presence of lamellated hyperintense synovitis in the MRI of hip arthroplasty showed high sensitivity and specificity for infection. This sign had substantial intra-observer reliability and moderate inter-observer reliability in the classification of the synovial pattern.
OBJECTIVE: To investigate the correlation between magnetic resonance imaging (MRI) lamellated hyperintense synovitis and periprosthetic infection of hip arthroplasty and estimate its value in the diagnosis of infection after hip replacement. METHODS: A retrospective analysis of 50 patients who underwent MRI from January 2016 to June 2019 after hip replacement was performed. The MRI scanning was performed with a 1.5T clinical imaging unit using SEMAC protocols. A total of 25 patients (cohort 1) showed infected total hip arthroplasty, and 25 patients had non-infected arthroplasty as controls (cohort 2). Two musculoskeletal radiologists, blinded to the clinical diagnosis, reviewed all the images for the presence of lamellated hyperintense synovitis independently. The cases were rereviewed by each reader after 2 weeks. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated using the first reads. The Kappa statistic was used to assess inter-observer and intra-observer reliability. RESULTS: The incidence of lamellated hyperintense synovitis was 76%-88% in the experimental group and 8%-16% in the control group. The sensitivity of lamellated hyperintense synovitis for infection was 0.80-0.88 (95% confidence interval [CI]:0.59 - 0.97), the specificity was 0.84~0.92 (95% CI: 0.64 -0.99), the positive predictive value 0.83-0.92 (95% CI: 0.67 - 0.98), the negative predictive value 0.81 - 0.88 (95% CI: 0.65 - 0.96). The agreement between two readers was substantial (Kappa = 0.76, 95% CI: 0.58 - 0.94, P < 0.05). There were moderate inter-observer agreements for both readers, reader 1 (Kappa = 0.48, 95%CI: 0.23 - 0.72, P < 0.05) and reader 2 (Kappa = 0.44，95% CI: 0.19 - 0.69, P < 0.05). CONCLUSION: In this cohort, the presence of lamellated hyperintense synovitis in the MRI of hip arthroplasty showed high sensitivity and specificity for infection. This sign had substantial intra-observer reliability and moderate inter-observer reliability in the classification of the synovial pattern.
Authors: Angela E Li; Darryl B Sneag; Harry G Greditzer; Christine C Johnson; Theodore T Miller; Hollis G Potter Journal: Radiology Date: 2016-05-27 Impact factor: 11.105
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Authors: José A López-López; Rachel L Humphriss; Andrew D Beswick; Howard H Z Thom; Linda P Hunt; Amanda Burston; Christopher G Fawsitt; William Hollingworth; Julian P T Higgins; Nicky J Welton; Ashley W Blom; Elsa M R Marques Journal: BMJ Date: 2017-11-02