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The average acquisition time was 6 minutes (range, 5?? MR image shows case characterized as ???Other??? ?384 (phase); and slice thickness, 3?? ?6; acquisition matrix, 512 (frequency) ?? 5). ?metal-on-metal disease??? The MRI examinations were evaluated by consensus agreement of two radiologists. ?associated lesions, multiacquisition variable-resonance image combination (MAVRIC), Review. 1 December 2012 | … The length of time since implant placement was significantly (p < 0.0001) increased in the THA group compared with the resurfacing arthroplasty group. Find out more about how we use your information in our Privacy Policy and Cookie Policy. ?24 cm; number of signals acquired, 0.5; acquisition matrix, 320?? The MRI will show a black spot around the stainless steel hip that could reach the prostate area and make the prostate images non-diagnostic or less useful. Obviously, there is nothing you can do to change this. ?6, 19]; however, the MRI appearance of aseptic lymphocytic vasculitis?? Not all implants are option… The interclass correlation coefficient between the two observers for synovitis volume was 0.99 (p < 0.0001). A diagnosis of aseptic lymphocytic vasculitis?? There are a few reasons why you might need to avoid MRI and … ?36 cm; number of signals acquired, 2; acquisition matrix, 256 (frequency) ?? Sections were evaluated for the presence of fibrinous exudates, necrosis, inflammatory cells (histiocytes, lymphocytes, plasma cells, eosinophils, and neutrophils), metallic debris, and aggregates of corrosion products. not corresponding to one of the patterns described (Figs. B, 51-year-old woman who presented for follow-up imaging 23 months after resurfacing arthroplasty. When they work well, metal-on-metal hip resurfacing and total hip replacements give years of trouble-free use with very low levels of wear. Osteolysis was detected in seven of the THA hips (24.1%), with a mean volume of 2.6 ?? The demographic, radiographic, and MRI findings in the resurfacing arthroplasty group and the THA group are summarized in Table 1. CONCLUSION. TABLE 2: Demographic, Radiographic, MRI, Operative, and Histologic Findings in 19 Patients Who Underwent Revision Surgery. However, those which have titanium implants can go for MRI, there is no harm. In the resurfacing arthroplasty group, tendinosis was detected in the gluteus medius tendon in 21 hips (67.7%), gluteus minimus in 16 hips (51.6%), and iliopsoas in 13 hips (41.9%). MATERIALS AND METHODS. OBJECTIVE. ?9 minutes) for a single imaging plane. ?associated lesions, radiographic findings were normal in seven. I have always been told I couldn't have one, due to the amount of stainless steel implants in my back. Outlined areas show regions of interest. Low-signal-intensity extracapsular disease (white arrows), which does not communicate with joint, is also present within abductor musculature. Either titanium or stainless steel. Evaluation of concurrent radiographs revealed an abnormality in four resurfacing arthroplasty hips and five THA hips (Table 1). The MAVRIC scan was acquired in the coronal plane using the following parameters: TR range, 4000?? Coronal fast spin-echo image shows synovitis communicating with pseudocapsule of hip (black arrows). We found that synovitis occurs in similar proportions of patients with a painful hip after resurfacing arthroplasty and after THA. After two shoulder replacement surgeries, Sylvia Klees was left with a lot of metal implanted in her body and a challenge when it comes to imaging. J … Fortunately, most implants, such as those used in knee and hip replacements, are made from metals such as titanium, which are safe to use in an MRI scanner. The MRI examinations of patients with metal-on-metal hip prostheses placed at resurfacing arthroplasty (n= 31) or THA (n= 29) were reviewed for osteolysis, synovitis, extracapsular … But in some instances an MRI scan may not be recommended. HuffPost is part of Verizon Media. ?4 mm [14]. ?34 ms; bandwidth, ?? Final diagnosis was aseptic lymphocytic vasculitis-associated lesions (score 9). Extracapsular disease and muscle edema were seen only in patients with aseptic lymphocytic vasculitis?? 256?? Yet this test isn't safe for everyone. The femoral, sciatic, and obturator nerves were assessed for the presence of neurovascular impingement. ?associated lesions [4?? MRI can also assess for periprosthetic soft-tissue collections or masses that may indicate aseptic lymphocytic vasculitis?? Both types … The gluteus medius, gluteus minimus, and iliopsoas were assessed for the presence of tendinosis, which were graded as normal, defined as showing uniformly low signal intensity without tendon thickening; mild tendinosis, increased signal intensity but no tendon thickening; moderate tendinosis, increased signal intensity with focal tendon thickening; or severe tendinosis, increased signal intensity with diffuse tendon thickening. If you have a hip replacement, knee replacement, a metal plate and screws, a metal rod inside your bone, or one of many … MRI of the Thumb: Anatomy and Spectrum of Findings in Asymptomatic Volunteers, Review. The Wilcoxon rank sum test was performed to detect differences in MRI findings in patients with and those without aseptic lymphocytic vasculitis?? The observation of a fluid collection or soft-tissue mass in the iliopsoas or trochanteric bursa in the setting of a metal-on-metal hip prosthesis should therefore prompt a careful search for a communication with the pseudocapsule. The histologic results of the tissue obtained from the patients who underwent revision surgery were analyzed by one musculoskeletal pathologist. ?associated lesions and the group without that diagnosis. ?512 (frequency) ?? In each case, extracapsular disease consisted of low-signal-intensity lesions dissecting within the hip abductor musculature. The presence of muscle atrophy, defined as loss of volume and the presence of fatty replacement, and the presence of muscle edema, defined as the presence of high signal intensity on inversion recovery images, was recorded. The volume of synovitis did not correlate to sex (p = 0.39), age (r = 0.32, p = 0.10), or BMI (r = 0.31, p = 0.12) in the THA group. The average acquisition time was 8 minutes (range, 6?? Chi-square tests were performed to detect differences between the resurfacing arthroplasty and THA groups. Hip replacements are among the most common orthopedic procedures. The most common synovial pattern in patients with histologically confirmed aseptic lymphocytic vasculitis?? ?129.7 cm3) and had a significantly (p = 0.02) higher rate of decompression of synovitis into adjacent bursae (83.3% vs 20.0%, respectively). The presence of tendon abnormalities and regional muscle atrophy has previously been proposed to be a marker of ???severe??? ?4.5 mm (Figs. Four patients in the resurfacing arthroplasty group and three patients in the THA group are awaiting surgery. MR image shows extensive proximal femoral osteolysis (arrows), which is seen as intermediate-signal-intensity material replacing normal high-signal-intensity fatty marrow. ?645.6 cm3) than cases without that diagnosis (26.4 ?? The volumes of osteolysis, synovitis, and extracapsular disease were calculated from either the axial FSE images or the coronal MAVRIC images using a previously validated manual segmentation method [9, 10]. Three of the five patients with extracapsular disease had undergone revision surgery; histology revealed aseptic lymphocytic vasculitis?? All tissue excised at surgery was submitted for histologic examination, serially cut, and extensively sampled to obtain maximum information. Standard anteroposterior pelvic and lateral hip radiographs were evaluated by an experienced musculoskeletal radiologist who was blinded to the MRI findings. This finding confirms the results of prior studies, which have shown periprosthetic fluid collections or soft-tissue lesions in 21.5?? Extracapsular disease was defined as fluid signal intensity or intermediate- to low-signal-intensity lesion adjacent to the prosthesis that did not communicate with the pseudocapsule of the hip (Fig. When a hip replacement is performed, the arthritic, damaged hip joint is removed. Neurovascular compression secondary to synovitis was detected in four of the resurfacing arthroplasty hips (12.9%) and two of the THA hips (6.9%) (Table 1). Edema was observed in four cases (gluteus medius, n = 1; gluteus medius and minimus, n = 1; iliopsoas, n = 2). 4A and 4B). A wide receiver bandwidth reduces interecho spacing, allowing longer echo-train lengths and a reduction in scanning time. A fast inversion recovery sequence was performed in the coronal plane using the following parameters: TR/TE, 4500/18; inversion time, 150 ms; bandwidth, ?? ?384 (phase); and slice thickness, 3?? 20.4 cm3 (range, 1.5?? ?Associated Lesions (ALVAL). In two cases, edema was observed in the abductor muscles due to an acute fracture of the greater trochanter. ?associated lesions had higher volumes of synovitis (p = 0.04) than patients without aseptic lymphocytic vasculitis?? A comparison of volume could not be performed because of the low numbers of patients in each group with osteolysis. Although tendon avulsion secondary to aseptic lymphocytic vasculitis?? Both the socket and the ball are made of stainless steel, … Short external rotator muscle atrophy is therefore an expected postoperative finding, particularly when a posterior approach is used for arthroplasty placement. Additional findings on MRI were recorded including fracture; stress reaction; marrow infiltration; or suspected component loosening, which was defined as circumferential bone resorption around the prosthesis. But some implants can … The finding ?? MRI can detect synovitis, osteolysis, and extracapsular disease as well as secondary complications such as neurovascular compression due to synovitis. 5 ?? Posthoc comparisons were performed when statistical significance was found. 3A, 3B, 3C, and 3D). Magnetic resonance imaging (MRI) is very safe and most people are able to have the procedure. Although conventional MRI is limited because of susceptibility artifacts generated by the cobalt-chromium components of the metal-on-metal prosthesis, prototype sequences have shown a reduction in artifacts and improved depiction of the surrounding soft tissues [12, 13]. Safety of Orthopedic Implants in Magnetic Resonance Imaging: An Experimental Verification Ritabh Kumar, 1Richard A. Lerski, 2Stephen Gandy, Benedict A. Clift, Rami J. Abboud1 … ?associated lesions. The ball-and-socket hip joint is then replaced with an artificial implant. There was no difference in the proportion of patients with osteolysis (p = 0.17) between the resurfacing arthroplasty and THA groups. All radiographic abnormalities were confirmed on MRI. In four cases, intermediate- to low-signal-intensity debris was also seen within the joint; two of these cases had a mixed pattern of aseptic lymphocytic vasculitis?? DePuy Synthes CFRE (Carbon Fibre Reinforced Epoxy) rods are considered MR conditional, but not DePuy Synthes stainless steel … 125 kHz; FOV, 20?? ?associated lesions. This method did not allow us to assess interobserver reliability; however, that assessment was not the aim of our study. Statistical significance for all analyses was taken at p < 0.05. ?associated lesions. Osteolysis was detected in three of the resurfacing arthroplasty hips (9.7%), with a mean volume of 10.2 ?? The coefficient of repeatability between the two observers was 0.25 cm3. ?associated lesions at revision surgery, reflecting the finding that incidental tendon abnormalities are common in patients after hip arthroplasty. Knowing about the different manufacturers, styles and materials will help you work with your surgeon to select the best implant for you beforehand. The objective of our study was to compare the frequency of osseous and soft-tissue abnormalities in patients presenting with hip pain after resurfacing arthroplasty and after total hip arthroplasty (THA), correlate the MRI findings with histologic results, and determine which MRI findings are predictive of aseptic lymphocytic vasculitis?? This debris is particles (ions) of cobalt and chromium that make up the implant. Short external rotator muscle atrophy was observed in 28 of the resurfacing arthroplasty hips (90.3%) and 23 of the THA hips (79.3%). 6). Regional muscles and tendons were assessed for tendinosis, tear, atrophy, and edema. In five of the 24 cases, synovitis was detected only on the MAVRIC images. ?16.5 cm3). 1C —42-year-old man with stainless steel radial head replacement. MR image shows synovitis to decompress posterolaterally into trochanteric bursa (arrows). metal-on-metal disease [6, 20]. Extracapsular disease was detected in two of the resurfacing arthroplasty hips (6.5%), with a mean volume of 36.6 ?? The finding of extracapsular low-signal-intensity lesions should therefore alert the radiologist to the possibility of aseptic lymphocytic vasculitis?? TABLE 1: Demographic, Radiographic, and MRI Findings in Resurfacing Arthroplasty Versus Total Hip Arthroplasty (THA) Groups. Copyright © 2013-2020, American Roentgen Ray Society, ARRS, All Rights Reserved. At the time of the study, one observer, a senior musculoskeletal MRI attending radiologist, had more than 10 years??? A Wilcoxon rank sum test was performed to detect differences between the resurfacing arthroplasty and THA groups in age, BMI, length of time since implantation, synovial volume, osteolysis volume, and extracapsular disease volume. There was no difference in the proportion of patients with extracapsular disease (p = 0.67) between the resurfacing arthroplasty and THA groups. 6 ?? 135.8 mm3) than the resurfacing arthroplasty group (31.3 ?? The THA group comprised 29 metal-onmetal hip implants in 27 patients (14 men, 13 women). We found no such correlation between the location of synovial decompression and the presence of solid or cystic disease in our cohort of 60 hips. Information about your device and internet connection, including your IP address, Browsing and search activity while using Verizon Media websites and apps. 2). The application of stainless steel has continued since its early use in the 1900s for surgical practices. ?41.0 cm3). The MRI examinations of patients with metal-on-metal hip prostheses placed at resurfacing arthroplasty (n = 31) or THA (n = 29) were reviewed for osteolysis, synovitis, extracapsular disease, synovial pattern, and mode of decompression into adjacent bursae. We also aimed to correlate the MRI appearance with operative and histologic findings in a subset of patients who underwent revision surgery to determine which MRI findings are most predictive of aseptic lymphocytic vasculitis?? Interclass correlation coefficients and coefficients of repeatability [18] were calculated between the two examiners for synovitis and osteolysis volume measurements. ?0.03, p = 0.87), or length of time since implant placement (r = 0.32, p = 0.08) in the resurfacing arthroplasty group. The higher incidence of synovitis observed in our study when compared with some previous studies may relate to the use of the prototype MAVRIC sequence, which has been shown to improve the depiction of synovitis around a hip prosthesis [12]. The presence of osteolysis, femoral neck resorption (for the resurfacing arthroplasty cases), periprosthetic lucency larger than 2 mm, fracture, component migration, a soft-tissue mass, and dense joint effusion was recorded. Extracapsular disease was present in three of the THA hips (10.3%), with a mean volume of 18.3 ?? A diagnosis of aseptic lymphocytic vasculitis?? stainless steel is used for a combination of such purposes. Extracapsular disease was observed in three cases in the group with aseptic lymphocytic vasculitis?? Current Concepts of Hip Arthroplasty for Radiologists: Part 2, Revisions and Complications. We thank Friedrich Boettner, Robert Buly, and Edwin Su for contributing patients to to this study and Parina Shah for assistance in performing the MAVRIC scans. We found no correlation between tendinosis or tendon tears and the presence of aseptic lymphocytic vasculitis?? An MRI study by Galea et al found that cobalt levels in the range of 2.9-3.2 parts per billion were associated with an increased risk of adverse local tissue reaction in patients who underwent metal-on-metal total hip arthroplasty or hip … Conventional radiographs of patients with aseptic lymphocytic vasculitis?? [17] for classifying aseptic lymphocytic vasculitis?? Keywords: adverse local tissue reaction, aseptic lymphocytic vasculitis?? Also note improved depiction of prosthesis-bone interface (white arrows, B) on MAVRIC image. A high readout matrix was applied to improve spatial resolution and to better define the interface between the implant and the surrounding structures. In the resurfacing arthroplasty group there was one case of metastatic disease, one avulsion fracture of the greater tuberosity, and one pathologic fracture of the pubic ramus associated with osteolysis. Synovitis was detected in 24 of the resurfacing arthroplasty hips (77.4%), with a mean volume of 31.3 ?? was recorded when the pseudocapsule of the hip was observed to be closely applied to the femoral neck or to the stem of the femoral component of the prosthesis. TABLE 3: Demographic and MRI Findings in Patients Who Underwent Revision Surgery Classified by Presence of Aseptic Lymphocytic Vasculitis?? All quantitative measurements were performed by one musculoskeletal radiologist. Edema was observed in both the gluteus medius and minimus in two cases. The acetabular component consisted of an Articular Surface Replacement (DePuy) in 15 hips, Birmingham Resurfacing system (Smith and Nephew) in eight hips, ReCap Acetabular Cup (Biomet Orthopedics) in two hips, Pinnacle Acetabular Cup (DePuy) in two hips, and Conserve Plus (Wright Medical) in one hip. ?associated lesions, hip resurfacing arthroplasty, metal-on-metal arthroplasty, MRI, multiacquisition variable-resonance image combination (MAVRIC), total hip arthroplasty. made of grade 400 stainless steel. This debris can trigger a response in your body, which can cause erosion of bone and loosening of the implants. ?associated lesions and metallic debris on histology. ?associated lesions is generated in the soft tissues. Medical supply companies sell stainless steel tools and accessories that staff can safely use in the MRI room. ?Methods of segmentation. Also note improved depiction of prosthesis-bone interface (white arrows, B) on MAVRIC image. A Spearman rank correlation analysis was performed to calculate the correlation coefficient (r) between the volume of synovitis and demographic data for each group. My wife broke her hip two years ago and now has 3 stainless steel screws in it. 48.3 cm3 (range, 0.3?? Paramagnetic materials have some attraction to magnetic fields, but if secured in position in the form of an implant, may be safe to use in standard MRI … MR image shows intermediate- to low-signal-intensity solid-appearing debris (arrows). ?associated lesions are high volumes of synovitis, extracapsular disease, and intramuscular edema. Can she have an MRI with the metal in there or will the metal screws interfere with the powerful magnets of the MRI … ?associated lesions. has been proposed [20]; however, this MRI grading system has not been correlated to patient outcome or histologic results [20]. Those persons which have stainless steel implants in their body can't go for MRI. The original implant type could not be determined in one case. 48.3 mm3); however, this difference did not reach statistical significance (p = 0.18). Many of these lesions correspond to aseptic lymphocytic vasculitis?? This further confirms the usefulness of MRI for assessing patients with metal-on-metal hip prostheses placed at arthroplasty because extensive soft-tissue abnormalities may occur even though radiographs show normal findings. ?associated lesions. The metal in most fillings is not affected by the MRI system's … Fig. ?associated lesions usually show normal findings despite the findings of extensive soft-tissue necrosis at revision surgery [4, 8]. We and our partners will store and/or access information on your device through the use of cookies and similar technologies, to display personalised ads and content, for ad and content measurement, audience insights and product development. Muscle edema was an uncommon finding, occurring in only five hips. Magnetic resonance imaging (MRI) An MRI scanner uses magnetic fields to take pictures of the brain. An MRI grading system for ?? The presence of extracapsular disease was recorded. In our study, we found that osteolysis was uncommon compared with synovitis; these findings confirm the hypothesis that the primary abnormality in patients with aseptic lymphocytic vasculitis?? I am scheduled for an MRI of my spine next week. ; in this case, fluid signal intensity with thickened intermediate-signal-intensity pseudocapsule (arrows) is seen. The presence of decompression of synovitis into adjacent bursae (iliopsoas bursa, trochanteric bursa, or both bursae) was recorded (Figs. 83?? However, some metal-on-metal implants can fail, increasing the amount of wear and producing small amounts of debris. MR image shows fluid signal intensity with thin pseudocapsule (arrows). Object Metal Object in person Metal keys steel hip replacement titanium watch steel joint pin stainless steel hair clip steel tooth fillings mixture of mercury, silver, tin, copper coins steel… ?6000 ms; TE range, 24?? ?associated lesions has not been clearly defined. In all cases, extracapsular disease consisted of low-signal-intensity lesions dissecting into the hip abductor muscles (two cases) or obturator internus muscle (one case). Synovitis was seen to decompress into adjacent bursae in 13 hips (52.0%): trochanteric bursa, six hips; iliopsoas bursa, three hips; and trochanteric and iliopsoas bursae, four hips. Field Perturbation Maps To provide a sense of the Dn 0 distributions found near metallic implants, Fig. Pseudotumors in association with well-functioning metal-on-metal hip prostheses: a case-control study using three-dimensional computed tomography and magnetic resonance imaging. We did perform coefficient-of-repeatability analyses for osteolysis and synovitis volumes; these results showed good agreement between the two observers with respect to volume measurements. ?198.1 cm3). Despite overall good outcomes with metal-on-metal hip prostheses [1], some studies have described periprosthetic fluid collections and soft-tissue masses complicating metal-on-metal prostheses [3???6]. Axial FSE image shows method of segmentation for measuring volume of synovitis. The clinical and radiographic … When Sylvia’s doctor said she needed an MRI… The Birmingham Hip Resurfacing system (Smith and Nephew) accounted for 29 of the implants and the Conserve Plus system (Wright Medical) accounted for two of the implants. Synovitis is common in patients with metal-on-metal hip prostheses and occurs with a similar incidence after resurfacing arthroplasty and after THA; osteolysis and extracapsular disease are uncommon. Usually, in replacement surgeries, titanium implants … 1A and 1B). ?associated lesions (Table 3). Atrophy of the short external rotator muscles was an extremely frequent finding, confirming the results of a study of asymptomatic patients after conventional metal-on-polyethylene hip arthroplasty [16]. Because an MRI is essentially a large magnet, it’s not safe to have any metal near the machine – especially when it’s part of an implant. The THA group had a higher mean volume of synovitis (62.1 ?? An additional prototype multiacquisition variable-resonance image combination (MAVRIC) scan designed to further reduce susceptibility artifact [12, 13] was acquired. Synovitis was detected in 77.4% of resurfacing arthroplasty hips and 86.2% of THA hips. ?6000 ms; TE range, 21?? The presence of visible gray ???metallic??? Of the 12 patients with confirmed aseptic lymphocytic vasculitis?? Muscle atrophy was observed in four cases: gluteus medius, one case; gluteus medius and minimus, one case; and iliopsoas, two cases. Earlier embolisation coils are made of stainless steel and consequently are weakly ferromagnetic, while recent coils are made from platinum or other alloy and are non-ferromagnetic. Intramuscular edema was observed only in cases with aseptic lymphocytic vasculitis?? To date, eight patients in the resurfacing arthroplasty group and 11 patients (12 hips) in the THA group have undergone THA conversion to a metal-on-polyethylene prosthesis. MRI is the most accurate method with which to detect and quantify osteolysis and wear-induced synovitis [9???11]. ?associated lesions on histology, which are characterized by perivascular or diffuse infiltrates of lymphocytes, often with extensive tissue necrosis [7]. ?87.1% of patients with a metal-on-metal prosthesis [5, 6, 20]. Extracapsular disease was classified as fluid signal intensity or intermediate- to low-signal-intensity on intermediate-TE FSE and inversion recovery sequences. I have two rods, and nine hooks, the … In one case, there was insufficient tissue submitted to pathology to allow a histologic diagnosis. 2 contingency tables) were performed to evaluate proportions of aseptic lymphocytic vasculitis?? There are multiple forms of stainless steel starting with the introduction of type 302 for its application in orthopedic surgery. It’s a pain enough (literally and figuratively) to get a hip replacement.You have to get diagnosed, receive a prognosis, schedule pre-surgery checkups, plan for your time away from work and … Ultimately, the hip replacement implant you end up with is selected by your surgeon depending on fit, your arthritic damage, activity level, weight, age, and other lifestyle factors. If the metal interferes too much with the MRI … The MAVRIC technique minimizes image distortions by combining multiple individual datasets that are acquired at frequency bands incrementally offset from the dominant proton frequency [13]. Subsequent patient follow-up was recorded from the clinical notes. A comparison of volume could not be performed because of the low numbers of patients in each group with extracapsular disease. Synovitis was seen to decompress into adjacent bursae in 14 hips (58.3%): trochanteric bursa, 10 hips; iliopsoas bursa, three hips; and trochanteric and iliopsoas bursae, one hip. Address correspondence to H. G. Potter ([email protected]edu). The presence or absence of a tear was graded as follows: 1, no tear; 2, partial-thickness tear; or 3, full-thickness tear. 46.4 cm3; range, 0.0?? 192 (phase); and slice thickness, 5 mm. ?weighted) fast spin-echo (FSE) images were obtained in three orthogonal planes. 1a) a CoCr hip-ball replacement and (Fig. This article is available for CME credit. Using the grading system proposed by Campbell et al. High-Resolution 3-T MRI of the Fingers: Review of Anatomy and Common Tendon and Ligament Injuries, Review. The scores were summed to yield the final aseptic lymphocytic vasculitis?? MRI, because of its superior ability to image soft tissues, can detect early signs of total joint replacement failure and is now considered to be the ideal method for imaging total joint replacements …

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