SynthesisSkeletal radiology2026
Metal-artefact-reduction MRI for diagnosing periprosthetic joint infection: a systematic review and meta-analysis.
Synthesis in Skeletal radiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundPeriprosthetic joint infection (PJI) remains one of the most serious. Advances in metal-artefact-reduction sequences (MARS) now allow for improved diagnostic quality imaging in the periprosthetic region. Early studies suggest the diagnostic efficacy of MARS, including subfeatures, yet no formal synthesis of available data exists.
methodsA systematic review and meta-analysis were conducted following PRISMA-DTA and PRISMA 2020 guidelines. Eligible studies include diagnostic accuracy studies reporting MARS-MRI compared with established reference standards, such as Musculoskeletal Infection Society (MSIS) or International Consensus Meeting (ICM) criteria, or intraoperative microbiology and histology. Adults (≥18 years) with hip, knee, or shoulder arthroplasty undergoing MRI for suspected infection or aseptic loosening were included. Comprehensive searches were conducted in PubMed, Embase, Scopus, and Web of Science, from 2005 onwards, without language restriction.
resultsA total of 11 studies were included in this meta-analysis evaluating MARS-MRI for diagnosing periprosthetic joint infection (PJI). Pooled performance demonstrated high diagnostic accuracy with sensitivity 0.88 (95% CI 0.72-0.95), specificity 0.95 (95% CI 0.80-0.99), and AUC 0.94. Subgroup analysis showed soft tissue changes had the best diagnostic performance (sensitivity 0.82, specificity 0.91), followed by synovitis and effusion, whilst bone changes were less accurate. Overall, MARS-MRI demonstrates excellent utility in diagnosing PJI.
conclusionMARS-MRI demonstrates high diagnostic accuracy for periprosthetic joint infection (sensitivity 0.88, specificity 0.95, AUC 0.94), particularly with soft tissue changes. It aids antimicrobial stewardship by reducing unnecessary interventions. Further large, multi-centre prospective studies are needed to strengthen evidence and validate clinical utility.
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