Background: Psoas muscle abscess (PMA) is an uncommon yet severe condition characterized
by diagnostic and therapeutic challenges due to its varied etiology and nonspecific
symptoms. This study aimed to evaluate the effectiveness and accuracy of various imaging
techniques used in the image-guided percutaneous drainage (PD) of PMA. Methods: A
systematic review was conducted following the PRISMA guidelines. We searched PubMed,
Google Scholar, and Science Direct for studies published in English from 1998 onwards
that reported on the use of PD in treating PMA, detailing outcomes and complications.
Imaging modalities guiding PD were also examined. Results: We identified 1570 articles,
selecting 39 for full review. Of these, 23 met the inclusion criteria; 19 were excluded
due to unspecified PMA, absence of imaging guidance for PD, or inconclusive results.
Eleven studies utilized computed tomography (CT) for PD, with six also using magnetic
resonance imaging (MRI). Ten studies implemented ultrasound (US)-guided PD; variations
in diagnostic imaging included combinations of US, CT, and MRI. A mixed approach using
both CT and US was reported in two articles. Most studies using CT-guided PD showed
complete success, while outcomes varied among those using US-guided PD. No studies
employed MRI-guided PD. Conclusions: This review supports a multimodal approach for
psoas abscess management, using MRI for diagnosis and CT for drainage guidance. We
advocate for Cone Beam CT (CBCT)-MRI fusion techniques with navigation systems to
enhance treatment precision and outcomes, particularly in complex cases with challenging
abscess characteristics.
