Can MRI accurately detect pilon articular malreduction? A quantitative comparison between CT and 3T MRI bone models

Abstract

Background: Pilon fracture reduction is a challenging surgery. Radiographs are commonly used to assess the quality of reduction, but are limited in revealing the remaining bone incongruities. The study aimed to develop a method in quantifying articular malreductions using 3D computed tomography (CT) and magnetic resonance imaging (MRI) models.Methods: CT and MRI data were acquired using three pairs of human cadaveric ankle specimens.Common tibial pilon fractures were simulated by performing osteotomies to the ankle specimens. Five of the created fractures [three AO type-B (43-B1), and two AO type-C (43-C1) fractures] were then reduced and stabilised using titanium implants, then rescanned. All datasets were reconstructed into CT and MRI models, and were analysed in regards to intra-articular steps and gaps, surface deviations, malrotations and maltranslations of the bone fragments.Results: Initial results reveal that type B fracture CT and MRI models differed by ~0.2 (step), ~0.18 (surface deviations), ~0.56° (rotation) and ~0.4 mm (translation). Type C fracture MRI models showed metal artefacts extending to the articular surface, thus unsuitable for analysis. Type C fracture CT models differed from their CT and MRI contralateral models by ~0.15 (surface deviation), ~1.63° (rotation) and ~0.4 mm (translation).Conclusions: Type B fracture MRI models were comparable to CT and may potentially be used for the postoperative assessment of articular reduction on a case-to-case basis.

Comparison of cartilage and bone morphological models of the ankle joint derived from different medical imaging technologies

“…This merging, either by SVD or ICP registration procedures, is still considered as the gold standard to obtain reconstructions of complete anatomical models of the diarthrodial joints, which can include the bones and the cartilage in between. The alternative would be defining these bones plus cartilage models from MRI scans only, but our present results show that the accuracy of the MRI-based bone models is higher than that of the gold STCT-based models, though a number of studies have claimed comparable results (20,(35)(36)(37)(38)(39)(40). MRI-based 3D models of the bone have shown comparable accuracy with respect to CT-based models (35)(36)(37)40,41), even in presence of normal and dysplastic anatomical structures (37).…”

“…This is expected to lead to a better accuracy in 3D bone modelling and therefore prosthesis design, because of a thorough representation of the patient-specific bone and joint morphology. Particularly, within high-resolution medical imaging technologies, such as computed tomography (CT) and magnetic resonance imaging (MRI), identification of anatomical structures are achieved (13,(18)(19)(20)(21), traditionally for bone segments and soft tissues including the cartilage, respectively.…”

“…A number of papers have claimed comparable accuracy of MRI-based bone models with respect to CT-based models (20,(35)(36)(37)(38)(39)(40), though some of these studies were for other joints, but the gold standard for bone and cartilage models reconstruction remains respectively CT and MRI imaging. To take advantage of this complementary information, merging techniques between these two different imaging technologies are being exploited (35,41).…”

Influence of Iodinated Magnetic Resonance Contrast Media and Isotope99mTc on Changes of Computed Tomography Number

“…As a result of measuring Noise before and after the distribution of ® . The reason why there was a difference in Noise before and after the distribution of 99m Tc was because of attenuation phenomena of X-ray due to dense substances such as tooth and metal, which occurs artifact [15], and the more attenuation occurs, the more noise will be created. Besides, there is a study that demonstrated that there is an artifact in metal substance used for filling of teeth such as metal, gold, and titanium [16] and it is considered to have a difference in Noise due to 99m Tc metal ion, which is a minute amount of VIIB radioactive metal substance melted in Normal Saline.…”

Current controversies in management of fracture neck femur in children: A review

“…Moreover, the size of artefact produced in Magnetic Resonance imaging is significantly small. 31 Hence, use of titanium screw is recommended as it promotes fracture healing and improves quality of post-operative assessment and detection of avascular necrosis of femoral head.…”