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Ali M, Benfante V, Di Raimondo D, Laudicella R, Tuttolomondo A, Comelli A. A Review of Advances in Molecular Imaging of Rheumatoid Arthritis: From In Vitro to Clinic Applications Using Radiolabeled Targeting Vectors with Technetium-99m. Life (Basel) 2024; 14:751. [PMID: 38929734 PMCID: PMC11204982 DOI: 10.3390/life14060751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 05/24/2024] [Accepted: 06/07/2024] [Indexed: 06/28/2024] Open
Abstract
Rheumatoid arthritis (RA) is a systemic autoimmune disorder caused by inflammation of cartilaginous diarthrodial joints that destroys joints and cartilage, resulting in synovitis and pannus formation. Timely detection and effective management of RA are pivotal for mitigating inflammatory arthritis consequences, potentially influencing disease progression. Nuclear medicine using radiolabeled targeted vectors presents a promising avenue for RA diagnosis and response to treatment assessment. Radiopharmaceutical such as technetium-99m (99mTc), combined with single photon emission computed tomography (SPECT) combined with CT (SPECT/CT), introduces a more refined diagnostic approach, enhancing accuracy through precise anatomical localization, representing a notable advancement in hybrid molecular imaging for RA evaluation. This comprehensive review discusses existing research, encompassing in vitro, in vivo, and clinical studies to explore the application of 99mTc radiolabeled targeting vectors with SPECT imaging for RA diagnosis. The purpose of this review is to highlight the potential of this strategy to enhance patient outcomes by improving the early detection and management of RA.
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Affiliation(s)
- Muhammad Ali
- Ri.MED Foundation, Via Bandiera 11, 90133 Palermo, Italy; (M.A.); (A.C.)
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Molecular and Clinical Medicine, University of Palermo, 90127 Palermo, Italy; (D.D.R.); (A.T.)
| | - Viviana Benfante
- Ri.MED Foundation, Via Bandiera 11, 90133 Palermo, Italy; (M.A.); (A.C.)
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Molecular and Clinical Medicine, University of Palermo, 90127 Palermo, Italy; (D.D.R.); (A.T.)
| | - Domenico Di Raimondo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Molecular and Clinical Medicine, University of Palermo, 90127 Palermo, Italy; (D.D.R.); (A.T.)
| | - Riccardo Laudicella
- Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Messina University, 98124 Messina, Italy;
| | - Antonino Tuttolomondo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Molecular and Clinical Medicine, University of Palermo, 90127 Palermo, Italy; (D.D.R.); (A.T.)
| | - Albert Comelli
- Ri.MED Foundation, Via Bandiera 11, 90133 Palermo, Italy; (M.A.); (A.C.)
- NBFC—National Biodiversity Future Center, 90133 Palermo, Italy
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Walker EA, Fox MG, Blankenbaker DG, French CN, Frick MA, Hanna TN, Jawetz ST, Onks C, Said N, Stensby JD, Beaman FD. ACR Appropriateness Criteria® Imaging After Total Knee Arthroplasty: 2023 Update. J Am Coll Radiol 2023; 20:S433-S454. [PMID: 38040463 DOI: 10.1016/j.jacr.2023.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 08/22/2023] [Indexed: 12/03/2023]
Abstract
Total knee arthroplasty is the most commonly performed joint replacement procedure in the United States. This manuscript will discuss the recommended imaging modalities for six clinical variants; 1. follow-up of symptomatic or asymptomatic patients with a total knee arthroplasty. Initial imaging, 2. Suspected infection after total knee arthroplasty. Additional imaging following radiographs, 3. Pain after total knee arthroplasty. Infection excluded. Suspect aseptic loosening or osteolysis or instability. Additional imaging following radiographs, 4. Pain after total knee arthroplasty. Suspect periprosthetic or hardware fracture. Additional imaging following radiographs, 5. Pain after total knee arthroplasty. Measuring component rotation. Additional imaging following radiographs, and 6. Pain after total knee arthroplasty. Suspect periprosthetic soft-tissue abnormality unrelated to infection, including quadriceps or patellar tendinopathy. Additional imaging following radiographs. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- Eric A Walker
- Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania; Uniformed Services University of the Health Sciences, Bethesda, Maryland.
| | | | - Donna G Blankenbaker
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Cristy N French
- Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | | | - Tarek N Hanna
- Emory University, Atlanta, Georgia; Committee on Emergency Radiology-GSER
| | | | - Cayce Onks
- Penn State Health, Hershey, Pennsylvania, Primary care physician
| | - Nicholas Said
- Duke University Medical Center, Durham, North Carolina
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Cretu B, Iordache S, Cursaru A, Serban B, Costache M, Cirstoiu C, Spiridonica R. Metagenomic Next-Generation Sequencing for Periprosthetic Joint Infections. Cureus 2023; 15:e38726. [PMID: 37168414 PMCID: PMC10166283 DOI: 10.7759/cureus.38726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2023] [Indexed: 05/13/2023] Open
Abstract
Periprosthetic joint infection (PJI) after arthroplasty is a major complication, which requires significant resources, resulting in high costs for the medical system. In recent years, significant progress has been made in the diagnosis and treatment of periprosthetic infections, the identification of the pathogen being the central element in the establishment of targeted antibiotic therapy. Next-generation sequencing (NGS) or metagenomic NGS (mNGS) represents a promising, fast alternative, with increased specificity and sensitivity compared to identification methods using conventional culture media, thus enabling an increased rate of identification of pathogenic microorganisms and antibiotic resistance genes (ARG). The purpose of this article was to highlight new molecular diagnostic methods for periprosthetic joint infections and their involvement in treatment efficiency. NGS technologies are cutting-edge techniques that may challenge the PJI diagnostic model.
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Affiliation(s)
- Bogdan Cretu
- Orthopedics and Traumatology, University Emergency Hospital, Bucharest, ROU
| | - Sergiu Iordache
- Orthopedics and Traumatology, University Emergency Hospital, Bucharest, ROU
| | - Adrian Cursaru
- Orthopedics and Traumatology, University Emergency Hospital, Bucharest, ROU
| | - Bogdan Serban
- Orthopedics and Traumatology, University Emergency Hospital, Bucharest, ROU
| | - Mihai Costache
- Orthopedics and Traumatology, University Emergency Hospital, Bucharest, ROU
| | - Catalin Cirstoiu
- Orthopedics and Traumatology, University Emergency Hospital, Bucharest, ROU
| | - Razvan Spiridonica
- Orthopedics and Traumatology, University Emergency Hospital, Bucharest, ROU
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Indelli PF, Ghirardelli S, Violante B, Amanatullah DF. Next generation sequencing for pathogen detection in periprosthetic joint infections. EFORT Open Rev 2021; 6:236-244. [PMID: 34040801 PMCID: PMC8142595 DOI: 10.1302/2058-5241.6.200099] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Periprosthetic joint infections (PJI) represent one of the most catastrophic complications following total joint arthroplasty (TJA). The lack of standardized diagnostic tests and protocols for PJI is a challenge for arthroplasty surgeons.Next generation sequencing (NGS) is an innovative diagnostic tool that can sequence microbial deoxyribonucleic acids (DNA) from a synovial fluid sample: all DNA present in a specimen is sequenced in parallel, generating millions of reads. It has been shown to be extremely useful in a culture-negative PJI setting.Metagenomic NGS (mNGS) allows for universal pathogen detection, regardless of microbe type, in a 24-48-hour timeframe: in its nanopore-base variation, mNGS also allows for antimicrobial resistance characterization.Cell-free DNA (cfDNA) NGS, characterized by lack of the cell lysis step, has a fast run-time (hours) and, together with a high sensitivity and specificity in microorganism isolation, may provide information on the presence of antimicrobial resistance genes.Metagenomics and cfDNA testing have reduced the time needed to detect infecting bacteria and represent very promising technologies for fast PJI diagnosis.NGS technologies are revolutionary methods that could disrupt the diagnostic paradigm of PJI, but a comprehensive collection of clinical evidence is still needed before they become widely used diagnostic tools. Cite this article: EFORT Open Rev 2021;6:236-244. DOI: 10.1302/2058-5241.6.200099.
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Affiliation(s)
- Pier F Indelli
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA
| | | | | | - Derek F Amanatullah
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA
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Hochman MG, Melenevsky YV, Metter DF, Roberts CC, Bencardino JT, Cassidy RC, Fox MG, Kransdorf MJ, Mintz DN, Shah NA, Small KM, Smith SE, Tynus KM, Weissman BN. ACR Appropriateness Criteria ® Imaging After Total Knee Arthroplasty. J Am Coll Radiol 2018; 14:S421-S448. [PMID: 29101982 DOI: 10.1016/j.jacr.2017.08.036] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 08/14/2017] [Indexed: 01/29/2023]
Abstract
Total knee arthroplasty (TKA) is the most commonly performed joint replacement procedure in the United States and annual demand for primary TKA is expected to grow by 673% by 2030. The first part provides an overview of imaging modalities (radiographs, CT, MRI, ultrasound, and various nuclear medicine studies) and discusses their usefulness in the imaging evaluation of TKA. The second part focuses on evidence-based imaging and imaging-guided intervention algorithms for the workup of TKA and its complications, including routine follow-up, component wear, periprosthetic infection, aseptic loosening, granulomas/osteolysis, conventional and rotational instability, periprosthetic fracture, patellar complications, and a variety of periprosthetic soft tissue abnormalities. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Mary G Hochman
- Principal Author, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
| | - Yulia V Melenevsky
- Research Author, Medical College of Georgia at Augusta University, Augusta, Georgia
| | - Darlene F Metter
- Co-author, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | | | - Jenny T Bencardino
- Panel Vice-Chair, New York University School of Medicine, New York, New York
| | - R Carter Cassidy
- UK Healthcare Spine and Total Joint Service, Lexington, Kentucky; American Academy of Orthopaedic Surgeons
| | | | | | | | - Nehal A Shah
- Brigham & Women's Hospital, Boston, Massachusetts
| | | | | | - Kathy M Tynus
- Northwestern Memorial Hospital, Chicago, Illinois; American College of Physicians
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Sonnow L, Könneker S, Vogt PM, Wacker F, von Falck C. Biodegradable magnesium Herbert screw - image quality and artifacts with radiography, CT and MRI. BMC Med Imaging 2017; 17:16. [PMID: 28196474 PMCID: PMC5310087 DOI: 10.1186/s12880-017-0187-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 02/03/2017] [Indexed: 01/03/2023] Open
Abstract
Background Magnesium alloys have recently been rediscovered as biodegradable implants in musculoskeletal surgery. This study is an ex-vivo trial to evaluate the imaging characteristics of magnesium implants in different imaging modalities as compared to conventional metallic implants. Methods A CE-approved magnesium Herbert screw (MAGNEZIX®) and a titanium screw of the same dimensions (3.2x20 mm) were imaged using different modalities: digital radiography (DX), multidetector computed tomography (MDCT), high resolution flat panel CT (FPCT) and magnetic resonance imaging (MRI). The screws were scanned in vitro and after implantation in a fresh chicken tibia in order to simulate surrounding bone and soft tissue. The images were quantitatively evaluated with respect to the overall image quality and the extent and intensity of artifacts. Results In all modalities, the artifacts generated by the magnesium screw had a lesser extent and were less severe as compared to the titanium screw (mean difference of artifact size of solo scanned screws in DX: 0.7 mm, MDCT: 6.2 mm, FPCT: 5.9 mm and MRI: 4.73 mm; p < 0.05). In MDCT and FPCT multiplanar reformations and 3D reconstructions were superior as compared with the titanium screw and the metal-bone interface after implanting the screws in chicken cadavers was more clearly depicted. While the artifacts of the titanium screw could be effectively reduced using metal-artifact reduction sequences in MRI (WARP, mean reduction of 2.5 mm, p < 0.05), there was no significant difference for the magnesium screw. Conclusions Magnesium implants generate significantly less artifacts in common imaging modalities (DX, MDCT, FPCT and MRI) as compared with conventional titanium implants and therefore may facilitate post-operative follow-up. Electronic supplementary material The online version of this article (doi:10.1186/s12880-017-0187-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lena Sonnow
- Department of Diagnostic and Interventional Radiology, Hannover, 30625, Germany.
| | - Sören Könneker
- Department of Plastic, Hand and Reconstructive Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Peter M Vogt
- Department of Plastic, Hand and Reconstructive Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Frank Wacker
- Department of Diagnostic and Interventional Radiology, Hannover, 30625, Germany
| | - Christian von Falck
- Department of Diagnostic and Interventional Radiology, Hannover, 30625, Germany
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No association between pseudotumors, high serum metal-ion levels and metal hypersensitivity in large-head metal-on-metal total hip arthroplasty at 5-7-year follow-up. Skeletal Radiol 2016; 45:115-25. [PMID: 26454451 DOI: 10.1007/s00256-015-2264-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 09/21/2015] [Accepted: 09/28/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The relationship between metal wear debris, pseudotumor formation and metal hypersensitivity is complex and not completely understood. The purpose of this study was to assess the prevalence of pseudotumor formation in a consecutive series of metal-on-metal (MoM) total hip arthroplasty (THA) and to investigate its relationship to serum metal-ion levels and hypersensitivity to metal. METHODS Forty-one patients (31 males), mean age 52 (28-68) years, with a total of 49 large-head MoM THA participated in a 5-7-year follow-up study. Patients underwent ultrasonography, serum metal-ion concentrations were measured, metal allergy and atopic dermatitis were evaluated, and the questionnaires of the Oxford Hip Score (OHS), Harris Hip Score (HHS) and the Short-Form Health Survey (SF-36) were completed. RESULTS Pseudotumors were found in eight patients, but they were asymptomatic and their serum metal-ion levels were similar to those observed in patients with no pseudotumors (p > 0.36). The capsule-stem distance of mean 8.6 mm (SD 3.82, 95% CI: 5.40-11.79) was wider (p = 0.02) in patients with pseudotumours than in patients without pseudotumors of mean 5.6 mm (SD 2.89, 95% CI: 4.68-6.58). Positive patch test reactions were seen in three patients. Higher serum metal-ion levels of chromium and cobalt were significantly correlated with steeper cup inclination and smaller femoral head sizes, and were associated with female gender (p < 0.04). CONCLUSION We found no association between pseudotumor formation, serum metal-ion levels, metal patch test reactivity, and atopic dermatitis. However, clinicians should be aware of asymptomatic pseudotumors, and we advise further exploration into the mechanisms involved in the pathogenesis of pseudotumors.
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Carbon fiber intramedullary nails reduce artifact in postoperative advanced imaging. Skeletal Radiol 2015; 44:1317-25. [PMID: 25982252 DOI: 10.1007/s00256-015-2158-9] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 04/17/2015] [Accepted: 04/20/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE This study assessed whether radiolucent carbon fiber reinforced-polyetheretherketone (CFR-PEEK) intramedullary nails decreased hardware artifact on magnetic resonance imaging (MRI) and computed tomography (CT) in vitro and in an oncologic patient population. MATERIALS AND METHODS In vitro and clinical evaluations were done. A qualitative assessment of metal artifact was performed using CFR-PEEK and titanium nail MRI phantoms. Eight patients with a femoral or tibial prophylactic CFR-PEEK nail were retrospectively identified. All patients had postoperative surveillance imaging by MRI, CT, and were followed for a median 20 months (range, 12-28 months). CFR-PEEK images were compared to images from a comparative group of patients with titanium femoral intramedullary nails who had a postoperative MRI or CT. A musculoskeletal-trained radiologist graded visualization of the cortex, corticomedullary junction, and bone-muscle interface, on T1-weighted (T1W), STIR, and contrast-enhanced T1-weighted fat-saturated (T1W FS) sequences of both groups with a five-point scale, performing independent reviews 4 months apart. Statistical analysis used the Wilcoxon rank-sum test and a weighted kappa. RESULTS Substantially less MRI signal loss occurred in the CFR-PEEK phantom than in the titanium phantom simulation, particularly as the angle increased with respect to direction of the static magnetic field. CFR-PEEK nails had less MRI artifact than titanium nails on scored T1W, STIR, and contrast-enhanced T1W FS MRI sequences (p ≤ 0.03). The mean weighted kappa was 0.64, showing excellent intraobserver reliability between readings. CONCLUSIONS CFR-PEEK intramedullary nail fixation is a superior alternative to minimize implant artifact on MRI or CT imaging for patients requiring long bone fixation.
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Elsissy P, Akpolat YT, Chien A, Cheng WK. MRI evaluation of the knee with non-ferromagnetic external fixators: cadaveric knee model. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2015; 25:933-9. [PMID: 26051439 DOI: 10.1007/s00590-015-1655-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 05/17/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The advent of MRI-compatible external fixation devices has made the use of MRI possible in patients who have been treated with external fixation. However, although there have been multiple studies determining the safety of MRI scans with external fixator devices, there are no studies determining the artifact effect these devices can have on the MRI image. The purpose of our study was to evaluate the effect of two popular brands (Stryker and Synthes) of MRI-compatible external fixators on the diagnostic capacity of a knee MRI. We hypothesize that (1) MRI images would have higher noise due to the presence of an external fixator and (2) images of high diagnostic capacity will be obtainable in the presence of each external fixator spanning the knee. METHODS Using seven cadaveric knees, a study was performed to analyze MRI images taken in the presence each external fixator. Scans taken with no external fixator present served as controls. Signal-to-noise ratios (SNRs) were measured at five anatomic structures. These structures were compared as a quantitative measure of image quality. A qualitative analysis was also performed using a five-point grading scale to assess the influence of metal artifact on the quality of the images. Each scan was graded by three blinded musculoskeletal radiologists focusing on six key anatomic structures. RESULTS A reduction in SNR was identified on the external fixator group compare to the control groups at the patella tendon, MM and PCL. Qualitative scoring by three expert radiologists showed no difference in ability to identify the six key anatomic landmarks between the Stryker, Synthes and control images. CONCLUSION Although the presence of external fixation devices does increase the noise artifact in MRI scans, patients treated with these external fixators can undergo MRI of local structures with high likelihood of obtaining diagnostic quality images.
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Affiliation(s)
- Peter Elsissy
- Department of Orthopaedic Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
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Lainiala O, Elo P, Reito A, Pajamäki J, Puolakka T, Eskelinen A. Good sensitivity and specificity of ultrasound for detecting pseudotumors in 83 failed metal-on-metal hip replacements. Acta Orthop 2015; 86:339-44. [PMID: 25582840 PMCID: PMC4443452 DOI: 10.3109/17453674.2014.1001970] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Ultrasound is used for imaging of pseudotumors associated with metal-on-metal (MoM) hips. Ultrasound has been compared with magnetic resonance imaging, but to date there have been no studies comparing ultrasound findings and revision findings. METHODS We evaluated the sensitivity and specificity of preoperative ultrasound for detecting pseudotumors in 82 patients with MoM hip replacement (82 hips). Ultrasound examinations were performed by 1 of 3 musculoskeletal radiologists, and pseudotumors seen by ultrasound were retrospectively classified as fluid-filled, mixed-type, or solid. Findings at revision surgery were retrieved from surgical notes and graded according to the same system as used for ultrasound findings. RESULTS Ultrasound had a sensitivity of 83% (95% CI: 63-93) and a specificity of 92% (CI: 82-96) for detecting trochanteric region pseudotumors, and a sensitivity of 79% (CI: 62-89) and a specificity of 94% (CI: 83-98) for detecting iliopsoas-region pseudotumors. Type misclassification of pseudotumors found at revision occurred in 8 of 23 hips in the trochanteric region and in 19 of 33 hips in the iliopsoas region. INTERPRETATION Despite the discrepancy in type classification between ultrasound and revision findings, the presence of pseudotumors was predicted well with ultrasound in our cohort of failed MoM hip replacements.
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Affiliation(s)
- Olli Lainiala
- Coxa Hospital for Joint Replacement, Tampere,
Finland
| | - Petra Elo
- Coxa Hospital for Joint Replacement, Tampere,
Finland
| | - Aleksi Reito
- Coxa Hospital for Joint Replacement, Tampere,
Finland
| | | | - Timo Puolakka
- Coxa Hospital for Joint Replacement, Tampere,
Finland
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Zou YF, Chu B, Wang CB, Hu ZY. Evaluation of MR issues for the latest standard brands of orthopedic metal implants: plates and screws. Eur J Radiol 2014; 84:450-457. [PMID: 25544555 DOI: 10.1016/j.ejrad.2014.12.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 12/02/2014] [Accepted: 12/04/2014] [Indexed: 11/18/2022]
Abstract
PURPOSE The study was performed to evaluate magnetic resonance (MR) issues for the latest standard brands of plates and screws used in orthopedic surgery at a 1.5-T MR system, including the safety and metallic artifacts. METHODS The plates and screws (made of titanium alloy and stainless steel materials, according to the latest standard brands) were assessed for displacement in degrees, MRI-related heating and artifacts at a 1.5-T MR system. The displacement in degrees of the plates and screws was evaluated on an angel-measurement instrument at the entrance of the MR scanner. The MRI-related heating was assessed on a swine leg fixed with a plate by using a "worst-case" pulse sequence. A rectangular water phantom was designed to evaluate metallic artifacts of a screw on different sequences (T1/T2-weighted FSE, STIR, T2-FSE fat saturation, GRE, DWI) and then artifacts were evaluated on T2-weighted FSE sequence by modifying the scanning parameters including field of view (FOV), echo train length (ETL) and bandwidth to identify the influence of parameters on metallic artifacts. 15 volunteers with internal vertebral fixation (titanium alloy materials) were scanned with MR using axial and sagittal T2-FSE, sagittal T2-FSE fat suppression and STIR with conventional and optimized parameters, respectively. Then all images were graded by two experienced radiologists having the experience of more than 7 years under double-blind studies that is neither of them knew which was conventional parameter group and optimized parameter group. RESULTS The average deflection angle of titanium alloy and stainless steel implants were 4.3° and 7.7°, respectively, (less than 45°) which indicated that the magnetically induced force was less than the weight of the object. The deflection angle of the titanium alloy implants was less than the stainless steel one (t=9.69, P<0.001). The average temperature changes of titanium alloy before and after the scan was 0.48°C and stainless steel implants was 0.74°C, respectively, with the background temperature changes of 0.24°C. The water phantom test indicated that the DWI sequence produced largest artifacts, while FSE pulse sequence produced smallest artifacts. And T2-weighted FSE fat saturation sequence produced larger artifacts than STIR sequence. The influence of the scanning parameters on metallic artifacts was verified that metallic artifacts increased with longer echo train length and bigger FOV, while decreased with larger bandwidth. The interreader agreement was good or excellent for each set of images graded with Cohen's Kappa statistic. Image grading of axial and sagittal T2-FSE with optimized parameters were significantly superior to that with conventional parameters (grade, 3.3±0.5 vs 2.7±0.6, P=0.003; 3.2±0.4 vs 1.9±0.7, P=0.001) and image of STIR sequence received a better grade than T2-FSE FS sequence (grade, 3.4±0.5 vs 1.7±0.6, P<0.001). CONCLUSIONS The latest standard plates and screws used in orthopedic surgery do not pose an additional hazard or risk to patients undergoing MR imaging at 1.5-T or less. Though artifacts caused by them cannot be ignored because of their relatively large size, it is possible to be minimized by choosing appropriate pulse sequences and optimizing scanning parameters, such as FSE and STIR sequence with large bandwidth, small FOV and appropriate echo train length.
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Affiliation(s)
- Yue-Fen Zou
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, China.
| | - Bin Chu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, China.
| | - Chuan-Bing Wang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, China.
| | - Zhi-Yi Hu
- Department of Spine Surgery, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, China.
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Bradshaw DA, Lam B, Hoffman R, Zicat B. Case report: Total knee arthroplasty polyethylene liner disengagement identified by arthrography. Knee 2014; 21:1288-90. [PMID: 25257776 DOI: 10.1016/j.knee.2014.07.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 06/15/2014] [Accepted: 07/21/2014] [Indexed: 02/02/2023]
Abstract
We report a case of total knee arthroplasty polyethylene liner disengagement identified by plain film arthrography and CT arthrography.
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Affiliation(s)
- David A Bradshaw
- Concord Repatriation General Hospital, Hospital Road, Concord, NSW, Australia.
| | - Brian Lam
- Concord Repatriation General Hospital, Hospital Road, Concord, NSW, Australia
| | - Rebekah Hoffman
- Concord Repatriation General Hospital, Hospital Road, Concord, NSW, Australia
| | - Bernard Zicat
- Concord Repatriation General Hospital, Hospital Road, Concord, NSW, Australia
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Nishii T, Sakai T, Takao M, Yoshikawa H, Sugano N. Is ultrasound screening reliable for adverse local tissue reaction after hip arthroplasty? J Arthroplasty 2014; 29:2239-44. [PMID: 24908625 DOI: 10.1016/j.arth.2014.04.030] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 03/27/2014] [Accepted: 04/22/2014] [Indexed: 02/01/2023] Open
Abstract
There is increasing awareness of prevalence of adverse local tissue reaction (ALTR) surrounding metal-on-metal (MoM) and highly cross-linked polyethylene (HXLPE) bearings, and sensitive and simple screening modalities for ALTR are required. We examined reliability of ultrasound screening for ALTR in 131 hips of 105 patients who received both ultrasound and MRI examinations after hip arthroplasty with MoM or HXLPE bearings. Using the MRI results as reference, sensitivity, specificity and accuracy of ultrasound were 74%, 92% and 84% around MoM bearings, and 90%, 83%, and 85% around HXLPE bearings. Ultrasound detected ALTR in 11 hips that were not shown with MRI. Ultrasound examination is assumed to be a reliable screening tool for detecting clinically important ALTR lesions developing in the anterior region around MoM or HXLPE bearings.
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Affiliation(s)
- Takashi Nishii
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Takashi Sakai
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Masaki Takao
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Hideki Yoshikawa
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Nobuhiko Sugano
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
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Matsuura Y, Kuniyoshi K, Suzuki T, Ogawa Y, Sukegawa K, Rokkaku T, Thoreson AR, An KN, Takahashi K. Accuracy of specimen-specific nonlinear finite element analysis for evaluation of radial diaphysis strength in cadaver material. Comput Methods Biomech Biomed Engin 2014; 18:1811-7. [PMID: 25374112 DOI: 10.1080/10255842.2014.974579] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The feasibility of a user-specific finite element model for predicting the in situ strength of the radius after implantation of bone plates for open fracture reduction was established. The effect of metal artifact in CT imaging was characterized. The results were verified against biomechanical test data. Fourteen cadaveric radii were divided into two groups: (1) intact radii for evaluating the accuracy of radial diaphysis strength predictions with finite element analysis and (2) radii with a locking plate affixed for evaluating metal artifact. All bones were imaged with CT. In the plated group, radii were first imaged with the plates affixed (for simulating digital plate removal). They were then subsequently imaged with the locking plates and screws removed (actual plate removal). Fracture strength of the radius diaphysis under axial compression was predicted with a three-dimensional, specimen-specific, nonlinear finite element analysis for both the intact and plated bones (bones with and without the plate captured in the scan). Specimens were then loaded to failure using a universal testing machine to verify the actual fracture load. In the intact group, the physical and predicted fracture loads were strongly correlated. For radii with plates affixed, the physical and predicted (simulated plate removal and actual plate removal) fracture loads were strongly correlated. This study demonstrates that our specimen-specific finite element analysis can accurately predict the strength of the radial diaphysis. The metal artifact from CT imaging was shown to produce an overestimate of strength.
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Affiliation(s)
- Yusuke Matsuura
- a Department of Orthopeadic Surgery , Graduate School of Medicine, Chiba University , 1-8-1 Inohana, Chuo-ku , Chiba 260-8670 , Japan
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15
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Deirmengian C, Kardos K, Kilmartin P, Cameron A, Schiller K, Parvizi J. Diagnosing periprosthetic joint infection: has the era of the biomarker arrived? Clin Orthop Relat Res 2014; 472:3254-62. [PMID: 24590839 PMCID: PMC4182392 DOI: 10.1007/s11999-014-3543-8] [Citation(s) in RCA: 264] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The diagnosis of periprosthetic joint infection (PJI) remains a serious clinical challenge. There is a pressing need for improved diagnostic testing methods; biomarkers offer one potentially promising approach. QUESTIONS/PURPOSES We evaluated the diagnostic characteristics of 16 promising synovial fluid biomarkers for the diagnosis of PJI. METHODS Synovial fluid was collected from 95 patients meeting the inclusion criteria of this prospective diagnostic study. All patients were being evaluated for a revision hip or knee arthroplasty, including patients with systemic inflammatory disease and those already receiving antibiotic treatment. The Musculoskeletal Infection Society (MSIS) definition was used to classify 29 PJIs and 66 aseptic joints. Synovial fluid samples were tested by immunoassay for 16 biomarkers optimized for use in synovial fluid. Sensitivity, specificity, and receiver operating characteristic curve analysis were performed to assess for diagnostic performance. RESULTS Five biomarkers, including human α-defensin 1-3, neutrophil elastase 2, bactericidal/permeability-increasing protein, neutrophil gelatinase-associated lipocalin, and lactoferrin, correctly predicted the MSIS classification of all patients in this study, with 100% sensitivity and specificity for the diagnosis of PJI. An additional eight biomarkers demonstrated excellent diagnostic strength, with an area under the curve of greater than 0.9. CONCLUSIONS Synovial fluid biomarkers exhibit a high accuracy in diagnosing PJI, even when including patients with systemic inflammatory disease and those receiving antibiotic treatment. Considering that these biomarkers match the results of the more complex MSIS definition of PJI, we believe that synovial fluid biomarkers can be a valuable addition to the methods utilized for the diagnosis of infection. LEVEL OF EVIDENCE Level II, diagnostic study. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Carl Deirmengian
- CD Diagnostics Inc, Lankenau Institute for Medical Research, 100 Lancaster Avenue, MOB 456, Wynnewood, PA 19096 USA ,The Rothman Institute, Thomas Jefferson University, Philadelphia, PA USA
| | - Keith Kardos
- CD Diagnostics Inc, Lankenau Institute for Medical Research, 100 Lancaster Avenue, MOB 456, Wynnewood, PA 19096 USA
| | - Patrick Kilmartin
- CD Diagnostics Inc, Lankenau Institute for Medical Research, 100 Lancaster Avenue, MOB 456, Wynnewood, PA 19096 USA
| | - Alexander Cameron
- CD Diagnostics Inc, Lankenau Institute for Medical Research, 100 Lancaster Avenue, MOB 456, Wynnewood, PA 19096 USA
| | - Kevin Schiller
- CD Diagnostics Inc, Lankenau Institute for Medical Research, 100 Lancaster Avenue, MOB 456, Wynnewood, PA 19096 USA
| | - Javad Parvizi
- The Rothman Institute, Thomas Jefferson University, Philadelphia, PA USA
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16
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VOLPE LUIGI, INDELLI PIERFRANCESCO, LATELLA LEONARDO, POLI PAOLO, YAKUPOGLU JALE, MARCUCCI MASSIMILIANO. Periprosthetic joint infections: a clinical practice algorithm. JOINTS 2014; 2:169-174. [PMID: 25750905 PMCID: PMC4334216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE periprosthetic joint infection (PJI) accounts for 25% of failed total knee arthroplasties (TKAs) and 15% of failed total hip arthroplasties (THAs). The purpose of the present study was to design a multidisciplinary diagnostic algorithm to detect a PJI as cause of a painful TKA or THA. METHODS from April 2010 to October 2012, 111 patients with suspected PJI were evaluated. The study group comprised 75 females and 36 males with an average age of 71 years (range, 48 to 94 years). Eighty-four patients had a painful THA, while 27 reported a painful TKA. The stepwise diagnostic algorithm, applied in all the patients, included: measurement of serum C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) levels; imaging studies, including standard radiological examination, standard technetium-99m-methylene diphosphonate (MDP) bone scan (if positive, confirmation by LeukoScan was obtained); and joint aspiration with analysis of synovial fluid. RESULTS following application of the stepwise diagnostic algorithm, 24 out of our 111 screened patients were classified as having a suspected PJI (21.7%). CRP and ESR levels were negative in 84 and positive in 17 cases; 93.7% of the patients had a positive technetium-labeled bone scan, and 23% a positive LeukoScan. Preoperative synovial fluid analysis was positive in 13.5%; analysis of synovial fluid obtained by preoperative aspiration showed a leucocyte count of > 3000 cells μ/l in 52% of the patients. CONCLUSIONS the present study showed that the diagnosis of PJI requires the application of a multimodal diagnostic protocol in order to avoid complications related to surgical revision of a misdiagnosed "silent" PJI. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- LUIGI VOLPE
- Articular Replacements Excellence Center (CESAT) – Fondazione Onlus “...In Cammino...”, Fucecchio, Italy
| | - PIER FRANCESCO INDELLI
- New Mexico Veterans Affairs Health Care System (NMVAHCS) and Adult Reconstruction University of New Mexico, Department of Orthopaedics and Rehabilitation, Albuquerque, New Mexico, USA
| | - LEONARDO LATELLA
- Articular Replacements Excellence Center (CESAT) – Fondazione Onlus “...In Cammino...”, Fucecchio, Italy
- Orthopedic Clinic, University of Florence School of Medicine, Italy
| | - PAOLO POLI
- Articular Replacements Excellence Center (CESAT) – Fondazione Onlus “...In Cammino...”, Fucecchio, Italy
| | - JALE YAKUPOGLU
- The Breyer Center for Overseas Studies, Stanford University in Florence, Italy
| | - MASSIMILIANO MARCUCCI
- Articular Replacements Excellence Center (CESAT) – Fondazione Onlus “...In Cammino...”, Fucecchio, Italy
- Orthopedic Clinic, University of Florence School of Medicine, Italy
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Mercuri L. Temporomandibular joint replacement periprosthetic joint infections: a review of early diagnostic testing options. Int J Oral Maxillofac Surg 2014; 43:1236-42. [DOI: 10.1016/j.ijom.2014.05.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 05/16/2014] [Accepted: 05/19/2014] [Indexed: 10/25/2022]
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Kohonen I, Koivu H, Vahlberg T, Larjava H, Mattila K. Total ankle arthroplasty: optimizing computed tomography imaging protocol. Skeletal Radiol 2013; 42:1507-13. [PMID: 23912198 DOI: 10.1007/s00256-013-1692-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 06/24/2013] [Accepted: 07/01/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate parameters and positioning when imaging total ankle prostheses on computed tomography (CT). MATERIALS AND METHODS An ankle prosthesis implanted into a pig's knee joint underwent 16 different CT imaging protocols. Four defects were drilled around prosthesis components simulating periprosthetic osteolytic lesions. The specimen with the implant was imaged in four different orientations with the tibial stem parallel to the table and at 25, 45, and 90° angles to it. The protocol consisted of scanning at 100, 120, and 140 kVp in every position with a pitch of 1.2. The scanning at 120 kVp in every position was repeated with a pitch of 1.0. RESULTS CT proved to be a reliable imaging modality when studying periprosthetic lesions adjacent to the ankle prosthesis when the tibial stem alignment was parallel to the table. When imaging at higher angles, metal artifacts distorted the image, making the analysis of periprosthetic bone structure unreliable. There were no statistically significant differences between different tube voltages or pitch in volume measurements of the osteolytic lesions. CONCLUSIONS CT is a reliable imaging method to evaluate periprosthetic bone structure around ankle prostheses when orientation of the prosthesis and acquisition parameters is optimized.
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Affiliation(s)
- Ia Kohonen
- Medical Imaging Centre of Southwest Finland, Turku University Hospital, Kiinamyllynkatu 4-8, 20520, Turku, Finland,
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Nishii T, Sakai T, Takao M, Yoshikawa H, Sugano N. Ultrasound screening of periarticular soft tissue abnormality around metal-on-metal bearings. J Arthroplasty 2012; 27:895-900. [PMID: 22047978 DOI: 10.1016/j.arth.2011.09.015] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Accepted: 09/16/2011] [Indexed: 02/01/2023] Open
Abstract
Although metal hypersensitivity or pseudotumors are concerns for metal-on-metal (MoM) bearings, detailed pathologies of patterns, severity, and incidence of periprosthetic soft tissue lesions are incompletely understood. We examined the potential of ultrasound for screening of periarticular soft tissue lesions around MoM bearings. Ultrasound examinations were conducted in 88 hips (79 patients) with MoM hip resurfacings or MoM total hip arthroplasties with a large femoral head. Four qualitative ultrasound patterns were shown, including normal pattern in 69 hips, joint-expansion pattern in 11 hips, cystic pattern in 5 hips, and mass pattern in 3 hips. Hips with the latter 3 abnormal patterns showed significantly higher frequency of clinical symptoms, without significant differences of sex, duration of implantation, head sizes, and cup abduction/anteversion angles, compared with hips with normal pattern. Ultrasound examination provides sensitive screening of soft tissue reactions around MoM bearings and may be useful in monitoring progression and defining treatment for periarticular soft tissue abnormalities.
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Affiliation(s)
- Takashi Nishii
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
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Nouh MR. Spinal fusion-hardware construct: Basic concepts and imaging review. World J Radiol 2012; 4:193-207. [PMID: 22761979 PMCID: PMC3386531 DOI: 10.4329/wjr.v4.i5.193] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Revised: 08/07/2011] [Accepted: 08/14/2011] [Indexed: 02/06/2023] Open
Abstract
The interpretation of spinal images fixed with metallic hardware forms an increasing bulk of daily practice in a busy imaging department. Radiologists are required to be familiar with the instrumentation and operative options used in spinal fixation and fusion procedures, especially in his or her institute. This is critical in evaluating the position of implants and potential complications associated with the operative approaches and spinal fixation devices used. Thus, the radiologist can play an important role in patient care and outcome. This review outlines the advantages and disadvantages of commonly used imaging methods and reports on the best yield for each modality and how to overcome the problematic issues associated with the presence of metallic hardware during imaging. Baseline radiographs are essential as they are the baseline point for evaluation of future studies should patients develop symptoms suggesting possible complications. They may justify further imaging workup with computed tomography, magnetic resonance and/or nuclear medicine studies as the evaluation of a patient with a spinal implant involves a multi-modality approach. This review describes imaging features of potential complications associated with spinal fusion surgery as well as the instrumentation used. This basic knowledge aims to help radiologists approach everyday practice in clinical imaging.
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Haroon A, Zumla A, Bomanji J. Role of Fluorine 18 Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography in Focal and Generalized Infectious and Inflammatory Disorders. Clin Infect Dis 2012; 54:1333-41. [DOI: 10.1093/cid/cis193] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
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22
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Recognition, assessment, and treatment of non-union after surgical fixation of fractures: emphasis on 3D CT. Jpn J Radiol 2011; 30:1-9. [DOI: 10.1007/s11604-011-0006-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Accepted: 07/31/2011] [Indexed: 02/07/2023]
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Value of 3D CT in Defining Skeletal Complications of Orthopedic Hardware in the Postoperative Patient. AJR Am J Roentgenol 2009; 193:1155-63. [DOI: 10.2214/ajr.09.2610] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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