Metal Artifact Reduction Sequences MRI: A Useful Reference for Preoperative Diagnosis and Debridement Planning of Periprosthetic Joint Infection

Abstract

The diagnosis and treatment of periprosthetic joint infection (PJI) is complex and the use of MRI in PJI is gaining attention from orthopedic surgeons as MR technology continues to advance. This study aimed to investigate whether metal artefact reduction sequence (MARS) MRI could be used as an adjunct in the preoperative diagnosis of PJI and to explore its role in PJI debridement planning. From January 2020 to November 2021, participants with metal joint prostheses that needed to be judged for infection were prospectively enrolled. According to Musculoskeletal Infection Society standards, 31 cases were classified as infection, and 20 as non-infection. The sensitivity and specificity of MARS MRI for the diagnosis of PJI were 80.65% and 75%, respectively. In MARS MRI, the incidence of bone destruction, lamellar synovitis, and extracapsular soft tissue oedema were significantly higher in PJI than in non-PJI. Fourteen suspicious occult lesions were found in the preoperative MARS MRI in 9 cases, and the location of 9 infection lesions was confirmed intraoperatively. In conclusion, MARS MRI is an effective diagnostic tool for PJIand can provide a visual reference for preoperative surgical planning.

Advances in Bone Joint Imaging-Metal Artifact Reduction

“…The metal artifact reduction sequence (MARS) was described by Olsen in 2000 [ 66 ]. Recent studies reported the usefulness of MARS for diagnosing periprosthetic infections of the shoulder [ 67 ] and hip and knee [ 68 ]. More advanced sequences for metal artifact reduction have been introduced, such as the view angle tilting (VAT) technique [ 69 ], WARP (a sequence commercialized by Siemens Healthcare, Erlangen, Germany) [ 65 ], slice encoding for metal artifact correction (SEMAC) [ 70 ], multi-acquisition variable-resonance image combination (MAVRIC) [ 71 ], and MAVRIC selective (MAVRIC SL) [ 72 ].…”

Role of MARS Protocol of MRI in Patellar Clunck Syndrome and Fracture Post of Polyethylene Liner: A Case Report

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The number of cases undergoing Total Knee Arthroplasty (TKA) has advanced manifolds in India and the role of Metal Artifacts Reduction Sequences (MARS) MRI is also gaining wide attention amongst Orthopaedicians/Radiologists for evaluation of painful knee after TKA or post TKA complications [1]. Here, we report a case of Patellar Clunk Syndrome (PCS) diagnosed on MRI with MARS sequence where the patient was also undertaken for Ultrasound for correlation.

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