Reliability of Slice-Encoding for Metal Artifact Correction (SEMAC) MRI to Identify Prosthesis Loosening in Patients with Painful Knee Arthroplasty: A Prospective, Single-Center, Surgical Validation Study

Tsuneari Takahashi; Siddharth Thaker; Giovanni Lettieri; Anthony Redmond; Michael R. Backhouse; Martin Stone; Philip J. O'Connor; Hemant Pandit

doi:10.1055/s-0045-1802970

Indian Journal of Radiology and Imaging, Table of Contents

CC BY-NC-ND 4.0 · Indian J Radiol Imaging
DOI: 10.1055/s-0045-1802970

Original Article

Reliability of Slice-Encoding for Metal Artifact Correction (SEMAC) MRI to Identify Prosthesis Loosening in Patients with Painful Knee Arthroplasty: A Prospective, Single-Center, Surgical Validation Study

Tsuneari Takahashi

¹Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom

²Department of Orthopaedic Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan

,

Siddharth Thaker

³Department of Radiology, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom

,

Giovanni Lettieri

¹Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom

⁴Chapel Allerton Hospital, Leeds Teaching Hospital NHS Trust, Leeds, United Kingdom

,

Anthony Redmond

¹Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom

⁴Chapel Allerton Hospital, Leeds Teaching Hospital NHS Trust, Leeds, United Kingdom

⁵The NIHR Leeds Biomedical Research Centre, Leeds, United Kingdom

,

Michael R. Backhouse

¹Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom

⁶Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom

,

Martin Stone

⁴Chapel Allerton Hospital, Leeds Teaching Hospital NHS Trust, Leeds, United Kingdom

⁵The NIHR Leeds Biomedical Research Centre, Leeds, United Kingdom

,

Philip J. O'Connor

⁴Chapel Allerton Hospital, Leeds Teaching Hospital NHS Trust, Leeds, United Kingdom

⁵The NIHR Leeds Biomedical Research Centre, Leeds, United Kingdom

,

Hemant Pandit

¹Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom

⁴Chapel Allerton Hospital, Leeds Teaching Hospital NHS Trust, Leeds, United Kingdom

⁵The NIHR Leeds Biomedical Research Centre, Leeds, United Kingdom

› Author Affiliations

Abstract

Objectives To validate reliability of slice-encoding for metal artifact correction (SEMAC) sequences in identifying prosthesis loosening in patients with painful knee arthroplasties (KAs) by comparing SEMAC-magnetic resonance imaging (MRI) findings to surgical outcomes—the gold standard.

Materials and Methods We prospectively followed 44 painful KA patients with possible aseptic prosthesis loosening at our tertiary care institution from 2011 to 2017. Potential cases of infective loosening were excluded making ours a selective study population. We acquired conventional and SEMAC-MRI images for all patients on 1.5-T MRI scanner. Two consultants scored MRI findings for complications such as osteolysis and bone marrow edema systematically. Scoring variations were settled by consensus. We used the Mann–Whitney U test and Wilcoxon signed-rank test for quantitative analysis and Spearman's rank-order correlation for correlation analysis of SEMAC findings and surgical outcomes, and followed the Outcome Measurements in Rheumatology filter methodology to assess the ability of SEMAC-MRI to detect prosthetic loosening.

Results Eleven patients needed revision surgery—seven had prosthesis loosening and four had retained native compartment osteoarthritis. Thirty-three were treated conservatively, of which 17 had spontaneous pain resolution and 8 had extra-articular causes—referred pain from hip (1 patient) and lumbar (7 patients) degeneration. Eight patients had adequate pain control without prosthesis loosening on follow-up. T1W-SEMAC identified surgically proven prosthesis loosening in all cases and short tau inversion recovery (STIR)-SEMAC diagnosed bone marrow edema (BME) in all our true positive cases. Sensitivity, specificity, positive predictive value, and negative predictive value of SEMAC-MRI for component loosening compared with gold standard were 100, 97.0, 88.9, and 100% in T1W-SEMAC, 75.0, 45.5, 25.0, and 88.2% in STIR-SEMAC, and 75.0, 93.9, 75.0, and 93.9% in proton density-weighted-SEMAC.

Conclusion SEMAC-MRI can accurately detect surgically verifiable prosthesis loosening and differentiate nonspecific BME from prosthesis loosening.

Keywords

knee arthroplasty - MRI - artifact reduction - SEMAC - revision surgery

Full Text

References

References
1 National Joint Registry for England Wales Northern Ireland and Isle of Man. Annual report. In. Hemel Hempstead, United Kingdom: National Joint Registry; 2015
2 Baker PN, van der Meulen JH, Lewsey J, Gregg PJ. National Joint Registry for England and Wales, Data from the National Joint Registry for England and Wales. The role of pain and function in determining patient satisfaction after total knee replacement. J Bone Joint Surg Br 2007; 89 (07) 893-900
3 Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KD. Patient satisfaction after total knee arthroplasty: who is satisfied and who is not?. Clin Orthop Relat Res 2010; 468 (01) 57-63
4 Fritz J, Lurie B, Potter HG. MR imaging of knee arthroplasty implants. Radiographics 2015; 35 (05) 1483-1501
5 Wolford ML, Palso K, Bercovitz A. Hospitalization for total hip replacement among inpatients aged 45 and over: United States, 2000-2010. NCHS Data Brief 2015; (186) 1-8
6 Williams SN, Wolford ML, Bercovitz A. Hospitalization for total knee replacement among inpatients aged 45 and over: United States, 2000-2010. NCHS Data Brief 2015; (210) 1-8
7 Fritz J, Lurie B, Miller TT, Potter HG. MR imaging of hip arthroplasty implants. Radiographics 2014; 34 (04) E106-E132
8 Plodkowski AJ, Hayter CL, Miller TT, Nguyen JT, Potter HG. Lamellated hyperintense synovitis: potential MR imaging sign of an infected knee arthroplasty. Radiology 2013; 266 (01) 256-260
9 Olsen RV, Munk PL, Lee MJ. et al. Metal artifact reduction sequence: early clinical applications. Radiographics 2000; 20 (03) 699-712
10 Matsuura H, Inoue T, Ogasawara K. et al. Quantitative analysis of magnetic resonance imaging susceptibility artifacts caused by neurosurgical biomaterials: comparison of 0.5, 1.5, and 3.0 Tesla magnetic fields. Neurol Med Chir (Tokyo) 2005; 45 (08) 395-398 , discussion 398–399
11 Jungmann PM, Agten CA, Pfirrmann CW, Sutter R. Advances in MRI around metal. J Magn Reson Imaging 2017; 46 (04) 972-991
12 Kumar NM, de Cesar Netto C, Schon LC, Fritz J. Metal artifact reduction magnetic resonance imaging around arthroplasty implants: the negative effect of long echo trains on the implant-related artifact. Invest Radiol 2017; 52 (05) 310-316
13 Cho ZH, Kim DJ, Kim YK. Total inhomogeneity correction including chemical shifts and susceptibility by view angle tilting. Med Phys 1988; 15 (01) 7-11
14 Ai T, Padua A, Goerner F. et al. SEMAC-VAT and MSVAT-SPACE sequence strategies for metal artifact reduction in 1.5T magnetic resonance imaging. Invest Radiol 2012; 47 (05) 267-276
15 Koch KM, Lorbiecki JE, Hinks RS, King KF. A multispectral three-dimensional acquisition technique for imaging near metal implants. Magn Reson Med 2009; 61 (02) 381-390
16 Koch KM, King KF, Carl M, Hargreaves BA. Imaging near metal: the impact of extreme static local field gradients on frequency encoding processes. Magn Reson Med 2014; 71 (06) 2024-2034
17 Hayter CL, Koff MF, Shah P, Koch KM, Miller TT, Potter HG. MRI after arthroplasty: comparison of MAVRIC and conventional fast spin-echo techniques. AJR Am J Roentgenol 2011; 197 (03) W405-11
18 Lu W, Pauly KB, Gold GE, Pauly JM, Hargreaves BA. SEMAC: slice encoding for metal artifact correction in MRI. Magn Reson Med 2009; 62 (01) 66-76
19 Agten CA, Del Grande F, Fucentese SF, Blatter S, Pfirrmann CW, Sutter R. Unicompartmental knee arthroplasty MRI: impact of slice-encoding for metal artefact correction MRI on image quality, findings and therapy decision. Eur Radiol 2015; 25 (07) 2184-2193
20 Chen CA, Chen W, Goodman SB. et al. New MR imaging methods for metallic implants in the knee: artifact correction and clinical impact. J Magn Reson Imaging 2011; 33 (05) 1121-1127
21 Sutter R, Ulbrich EJ, Jellus V, Nittka M, Pfirrmann CW. Reduction of metal artifacts in patients with total hip arthroplasty with slice-encoding metal artifact correction and view-angle tilting MR imaging. Radiology 2012; 265 (01) 204-214
22 Sneag DB, Bogner EA, Potter HG. Magnetic resonance imaging evaluation of the painful total knee arthroplasty. Semin Musculoskelet Radiol 2015; 19 (01) 40-48
23 Pusey E, Lufkin RB, Brown RK. et al. Magnetic resonance imaging artifacts: mechanism and clinical significance. Radiographics 1986; 6 (05) 891-911
24 Tartaglino LM, Flanders AE, Vinitski S, Friedman DP. Metallic artifacts on MR images of the postoperative spine: reduction with fast spin-echo techniques. Radiology 1994; 190 (02) 565-569
25 Sutter R, Hodek R, Fucentese SF, Nittka M, Pfirrmann CW. Total knee arthroplasty MRI featuring slice-encoding for metal artifact correction: reduction of artifacts for STIR and proton density-weighted sequences. AJR Am J Roentgenol 2013; 201 (06) 1315-1324
26 Jawhar A, Reichert M, Kostrzewa M. et al. Usefulness of slice encoding for metal artifact correction (SEMAC) technique for reducing metal artifacts after total knee arthroplasty. Eur J Orthop Surg Traumatol 2019; 29 (03) 659-666
27 Koch KM, Brau AC, Chen W. et al. Imaging near metal with a MAVRIC-SEMAC hybrid. Magn Reson Med 2011; 65 (01) 71-82
28 Filli L, Jud L, Luechinger R. et al. Material-dependent implant artifact reduction using SEMAC-VAT and MAVRIC: a prospective MRI Phantom Study. Invest Radiol 2017; 52 (06) 381-387
29 Boers M, Beaton DE, Shea BJ. et al. OMERACT filter 2.1: elaboration of the conceptual framework for outcome measurement in health intervention studies. J Rheumatol 2019; 46 (08) 1021-1027
30 Sonnow L, Gilson WD, Raithel E, Nittka M, Wacker F, Fritz J. Instrument visualization using conventional and compressed sensing SEMAC for interventional MRI at 3T. J Magn Reson Imaging 2017
31 Bachschmidt TJ, Sutter R, Jakob PM, Pfirrmann CW, Nittka M. Knee implant imaging at 3 Tesla using high-bandwidth radiofrequency pulses. J Magn Reson Imaging 2015; 41 (06) 1570-1580