Comparison of CT, MRI, and Radiographs in Assessing Pelvic Osteolysis

Walde, Tim Alexander; Weiland, Daniel E.; Leung, Serena B.; Kitamura, Nobuto; Sychterz, Christi J.; Claus, Alexandra M.; Potter, Hollis G.; Engh, Charles A.

doi:10.1097/01.blo.0000164028.14504.46

Cited by 174 publications

(124 citation statements)

References 14 publications

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“…3). The volumes of synovitis and osteolysis were calculated using a previously validated method of manual segmentation from the coronal MAVRIC or axial FSE images [26,32]. The pseudocapsule was evaluated for dehiscence, which was characterized by either anterior or posterior capsular detachment.…”

Section: Methodsmentioning

confidence: 99%

MRI Predicts ALVAL and Tissue Damage in Metal-on-Metal Hip Arthroplasty

Nawabi

Gold

Lyman

et al. 2013

Clin Orthop Relat Res

122

132

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Background Adverse local tissue reactions (ALTR) around metal-on-metal (MOM) hip arthroplasties are increasingly being recognized as a cause of failure. These reactions may be associated with intraoperative tissue damage and complication rates as high as 50% after revision. Although MRI can identify ALTR in MOM hips, it is unclear whether the MRI findings predict those at revision surgery.Questions/purposes We therefore (1) identified which MRI characteristics correlated with histologically confirmed ALTR (using the aseptic lymphocytic vasculitisassociated lesions [ALVAL] score) and intraoperative tissue damage and (2) developed a predictive model using modified MRI to detect ALVAL and quantify intraoperative tissue damage. Methods We retrospectively reviewed 68 patients with failed MOM hip arthroplasties who underwent preoperative MRI and subsequent revision surgery. Images were analyzed to determine synovial volume, osteolysis, and synovial thickness. The ALVAL score was used to grade tissue samples, thus identifying a subset of patients with ALTR. Intraoperative tissue damage was graded using a four-point scale. Random forest analysis determined the sensitivity and specificity of MRI characteristics in detecting ALVAL (score C 5) and intraoperative tissue damage. Results Maximal synovial thicknesses and synovial volumes as determined on MRI correlated with the ALVAL score and were higher in cases of severe intraoperative tissue damage. Our MRI predictive model showed sensitivity and specificity of 94% and 87%, respectively, for detecting ALVAL and 90% and 86%, respectively, for quantifying intraoperative tissue damage.

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Section: Methodsmentioning

confidence: 99%

MRI Predicts ALVAL and Tissue Damage in Metal-on-Metal Hip Arthroplasty

Nawabi

Gold

Lyman

et al. 2013

Clin Orthop Relat Res

122

132

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“…MRI is the most accurate imaging modality for the assessment of periprosthetic osteolysis and wear-induced synovitis (4)(5)(6). MRI also allows assessment of regional tendons and neurovascular structures, which are a potential cause of pain in a patient with a painful arthroplasty who is being considered for revision surgery.…”

Section: Instructions On Receiving Creditmentioning

confidence: 99%

“…CT also has the disadvantage of exposing the patient to ionizing radiation and the techniques required to minimize beam-hardening artifact in the presence of metallic implants even further increase the effective dose to the patient, which can prove a burden in the setting of serial examinations. MRI is superior to conventional radiographs and CT in the assessment of periprosthetic osteolysis and has been shown to be the most sensitive method to quantify the extent of periprosthetic osteolysis (5,6). In a cadaveric model of simulated osteolysis surrounding hip implants, MRI demonstrates a sensitivity of 95%, compared to CT (with high kVp) of 75% and radiographs (including oblique views) of 52%, with similar specificities, thus indicating MRI was the most accurate means by which to detect and quantify periprosthetic bone loss (5).…”

Section: Periprosthetic Osteolysismentioning

confidence: 99%

Magnetic resonance imaging of the postoperative hip

Hayter

Koff

Potter

2012

Magnetic Resonance Imaging

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Magnetic resonance imaging (MRI) is ideally suited to imaging the patient with painful hip arthroplasty due to its superior soft tissue contrast, multiplanar capabilities, and lack of ionizing radiation. MRI is the most accurate imaging modality in the assessment of periprosthetic osteolysis and wear‐induced synovitis, and can also assess regional tendons and neurovascular structures. This article discusses the technical aspects of MRI around metallic implants as well as the appearance of potential complications following hip arthroplasty, including osteolysis, wear‐induced synovitis, infection, hemarthrosis, fracture, loosening, component displacement, heterotopic ossification, tendinopathy, and neurovascular impingement. The specific complication of metal hypersensitivity following metal‐on‐metal prostheses is reviewed. J. Magn. Reson. Imaging 2012;35:1013‐1025. © 2012 Wiley Periodicals, Inc.

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“…In recent years, there have been numerous studies examining its role in imaging THA [3,7,38,39,46,[50][51][52]. MRI is effective for detecting periarticular bony and soft-tissue abnormalities in patients with a postarthroplasty hip [3,39,46,52], as well as determining the source of enigmatic hip following THA [7].…”

Section: Introductionmentioning

confidence: 99%

Early Reactive Synovitis and Osteolysis after Total Hip Arthroplasty

Cooper

Ranawat

Potter

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Background Little is known about intraarticular pathology following THA prior to the radiographic appearance of osteolysis, primarily due to imaging limitations. MRI has recently been applied to imaging the postarthroplasty hip with the ability to detect periarticular bony and soft tissue pathology; specifically, it is able to detect abnormal synovial patterns and focal bone loss well before the radiographic appearance of osteolysis. Questions/purposes We therefore used MRI to determine the incidence of early reactive synovitis and osteolysis in asymptomatic patients after THA, and whether there is an association between these MRI findings and clinical outcomes or radiographic wear measurements at this early stage. Methods We recruited 31 patients (33 hips) who underwent routine noncemented THA with one of three types of bearing surfaces: metal-on-cross-linked polyethylene (n = 7), ceramic-on-ceramic (n = 12), and ceramic-on-cross-linked polyethylene (n = 14). Patients underwent specialized MRI at a minimum of 12 months (mean, 23 months; range, 12-37 months) after surgery. MR images were analyzed for the presence of synovitis or osteolysis. WOMAC scores, patient assessment questionnaires, and radiographic wear measurements were correlated with MRI findings. Results Reactive synovitis was observed in 13 of 33 patients (39%) and focal osteolysis in one of 33 (3%). The presence of synovitis did not correlate with pain, activity level, patient satisfaction or clinical outcome scales, nor did it correlate with radiographic wear measurements at early followup. Conclusions Our observations suggest reactive synovitis is common yet asymptomatic at short-term followup. We do not know either the etiology or the long-term implications of these observations.

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Comparison of CT, MRI, and Radiographs in Assessing Pelvic Osteolysis

Cited by 174 publications

References 14 publications

MRI Predicts ALVAL and Tissue Damage in Metal-on-Metal Hip Arthroplasty

MRI Predicts ALVAL and Tissue Damage in Metal-on-Metal Hip Arthroplasty

Magnetic resonance imaging of the postoperative hip

Early Reactive Synovitis and Osteolysis after Total Hip Arthroplasty

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