CT与MRI在假体周围感染诊断中的价值对比：一项回顾性队列研究

Comparison of Value of CT and MRI in the Diagnosis of Periprosthetic Joint Infection: A Retrospective Cohort Study

摘要: 目的：对比计算机断层扫描(CT)与磁共振成像(MRI)在关节假体周围感染(PJI)中的诊断价值，为临床优化PJI影像学诊断方案提供依据。方法：回顾性分析2020年1月至2024年12月在我院及市人民医院接受关节置换术后疑似PJI患者126例的临床资料，所有患者均先后完成CT和MRI检查，并以术后病理检查结果(金标准)或临床综合诊断结果为依据，将患者分为感染组(68例)和非感染组(58例)。对比两种检查方法的诊断敏感性、特异性、准确性、阳性预测值(PPV)及阴性预测值(NPV)，分析两种方法对PJI典型影像学征象的检出能力。结果：病理及临床综合诊断确诊PJI 68例，非PJI 58例。MRI诊断PJI的敏感性(92.65%)、准确性(89.68%)及NPV (91.38%)均显著高于CT (分别为75.00%、78.57%、76.74%)，差异有统计学意义(P < 0.05)；两种检查方法的特异性(CT 83.62%, MRI 86.21%)及PPV (CT 82.61%, MRI 87.84%)比较，差异无统计学意义(P > 0.05)。在影像学征象检出方面，MRI对假体周围软组织水肿、骨髓炎、关节腔积液/积脓的检出率(分别为94.12%、88.24%、97.06%)显著高于CT (分别为67.65%、61.76%、79.41%)，差异有统计学意义(P < 0.05)；而CT对假体松动、骨溶解的检出率(分别为83.82%、80.88%)与MRI (分别为79.41%、77.94%)比较，差异无统计学意义(P > 0.05)。结论：在PJI诊断中，MRI的整体诊断效能优于CT，尤其在软组织感染、骨髓炎等征象的检出方面具有明显优势；CT则在假体松动、骨溶解的评估中具有一定价值，临床可根据患者具体情况选择单一检查或联合应用，以提高PJI诊断的准确性。

Abstract: Objective: To compare the diagnostic value of computed tomography (CT) and magnetic resonance imaging (MRI) in periprosthetic joint infection (PJI), and to provide evidence for optimizing the imaging diagnostic protocol of PJI in clinical practice. Methods: The clinical data of 126 patients with suspected PJI after joint replacement admitted to our hospital and the Municipal People’s Hospital from January 2020 to December 2024 were retrospectively analyzed. All patients underwent sequential CT and MRI examinations. Based on the postoperative pathological results (gold standard) or comprehensive clinical diagnostic results, the patients were divided into the infection group (68 cases) and the non-infection group (58 cases). The diagnostic sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of the two examination methods were compared, and their detection capabilities for typical imaging signs of PJI were analyzed. Results: A total of 68 cases of PJI and 58 cases of non-PJI were confirmed by pathology and comprehensive clinical diagnosis. The sensitivity (92.65%), accuracy (89.68%) and NPV (91.38%) of MRI in the diagnosis of PJI were significantly higher than those of CT (75.00%, 78.57% and 76.74%, respectively), with statistically significant differences (P < 0.05). There were no statistically significant differences in specificity (83.62% for CT vs 86.21% for MRI) and PPV (82.61% for CT vs 87.84% for MRI) between the two methods (P > 0.05). In terms of detection of imaging signs, the detection rates of MRI for periprosthetic soft tissue edema, osteomyelitis, and joint effusion/empyema (94.12%, 88.24% and 97.06%, respectively) were significantly higher than those of CT (67.65%, 61.76% and 79.41%, respectively), with statistically significant differences (P < 0.05). However, there were no statistically significant differences in the detection rates of prosthetic loosening and osteolysis between CT (83.82% and 80.88%, respectively) and MRI (79.41% and 77.94%, respectively) (P > 0.05). Conclusion: In the diagnosis of PJI, the overall diagnostic efficacy of MRI is superior to that of CT, and it has obvious advantages, especially in the detection of signs such as soft tissue infection and osteomyelitis. CT has a certain value in the evaluation of prosthetic loosening and osteolysis. In clinical practice, a single examination or combined application can be selected according to the specific conditions of patients to improve the diagnostic accuracy of PJI.