Akademik Veri Yönetim Sistemi
Knee Surgery, Sports Traumatology, Arthroscopy, 2026 (SCI-Expanded, Scopus)
Purpose: The diagnostic accuracy of imaging modalities in periprosthetic joint infections (PJIs) remains uncertain. This study assessed and compared the performance of different imaging techniques for diagnosing PJI. Methods: A systematic review and meta-analysis of studies published in PubMed and Embase (1 January 2000 to 1 March 2024) was conducted. Eligible studies included adults (≥18 years), applied a valid reference standard for PJI diagnosis, and provided sufficient data to construct 2 × 2 contingency tables. Imaging modalities included white blood cell scintigraphy (WBCS), FDG-PET/CT, antigranulocyte scintigraphy (AGS), bone scintigraphy (BS), magnetic resonance imaging (MRI), computed tomography (CT) and related combinations. Risk of bias was assessed using the QUADAS-2 tool. A bivariate random-effects model estimated pooled diagnostic odds ratios, sensitivities, and specificities with 95% confidence intervals (CIs). Results: Forty studies (1263 PJI cases, 4700 controls) were included. Pooled sensitivity and specificity were as follows: WBCS-SPECT/CT: 87.1% (95% CI, 31.7–99.0) and 94.1% (95% CI, 87.5–97.3); WBCS-BMS: 79.7% (95% CI, 58.3–91.7) and 94.2% (95% CI, 91.0–96.3); WBCS: 88.1% (95% CI, 73.8–95.1) and 80.0% (95% CI, 62.2–90.7); FDG-PET (±PET/CT): 88.1% (95% CI, 79.9–93.2) and 87.2% (95% CI, 76.3–93.5); BS-WBCS: 59.5% (95% CI, 43.2–73.9) and 96.6% (95% CI, 92.2–98.6); BS: 89.3% (95% CI, 80.9–94.2) and 74.1% (95% CI, 59.0–85.0); AGS: 89.1% (95% CI, 76.8–95.3) and 73.0% (95% CI, 63.1–81.0). No eligible studies were identified for MRI or CT. Substantial heterogeneity was observed. Conclusion: Diagnostic performance varied substantially, and no modality consistently demonstrated superior accuracy. WBCS showed the most stable results, particularly when combined with BS or BMS. Given the heterogeneity and variability in specificity, imaging should complement comprehensive diagnostic evaluation rather than be used in isolation. Level of Evidence: 2a–3a, systematic review and meta-analysis of retrospective cohort and case-control studies.