Selenium Nanoparticles Attenuate Cobalt Nanoparticle-Induced Skeletal Muscle Injury: A Study Based on Myoblasts and Zebrafish

Cobalt alloys have numerous applications, especially as critical components in orthopedic biomedical implants. However, recent investigations have revealed potential hazards associated with the release of nanoparticles from cobalt-based implants during implantation. This can lead to their accumulation and migration within the body, resulting in adverse reactions such as organ toxicity. Despite being a primary interface for cobalt nanoparticle (CoNP) exposure, skeletal muscle lacks comprehensive long-term impact studies. This study evaluated whether selenium nanoparticles (SeNPs) could mitigate CoNP toxicity in muscle cells and zebrafish models. CoNPs dose-dependently reduced C2C12 viability while elevating reactive oxygen species (ROS) and apoptosis. However, low-dose SeNPs attenuated these adverse effects. CoNPs downregulated myogenic genes and α-smooth muscle actin (α-SMA) expression in C2C12 cells; this effect was attenuated by SeNP cotreatment. Zebrafish studies confirmed CoNP toxicity, as it decreased locomotor performance while inducing muscle injury, ROS generation, malformations, and mortality. However, SeNPs alleviated these detrimental effects. Overall, SeNPs mitigated CoNP-mediated cytotoxicity in muscle cells and tissue through antioxidative and antiapoptotic mechanisms. This suggests that SeNP-coated implants could be developed to eliminate cobalt nanoparticle toxicity and enhance the safety of metallic implants.

A nonlinear scaling-based normalized metal artifact reduction to reduce low-frequency artifacts in energy-integrating and photon-counting CT

BACKGROUND

Metal within the scan plane can cause severe artifacts when reconstructing X-ray computed tomography (CT) scans. Both in clinical use and recent research, normalized metal artifact reduction (NMAR) has established as the reference method for correcting metal artifacts, but NMAR introduces inconsistencies within the sinogram, which can cause additional low-frequency artifacts after image reconstruction.

PURPOSE

This paper introduces an extension to NMAR by applying a nonlinear scaling function (NLS-NMAR) to reduce low-frequency artifacts, which get introduced by the reconstruction of interpolation-edge-related sinogram inconsistencies in the normalized sinogram domain.

METHODS

After linear interpolation of the metal trace, an NLS function is applied in the prior-normalized sinogram domain to reduce the impact of the interpolation edges during filtered backprojection. After sinogram denormalization and image reconstruction, the low frequencies of the NLS image are combined with different high frequencies to restore anatomic details. An anthropomorphic dental phantom with removable metal inserts was utilized on two different CT systems to quantitatively assess the artifact reduction performance in terms of HU deviations and the root-mean-square-error within relevant regions of interest. Clinical dental examples were assessed to qualitatively demonstrate the problem of the interpolation-related blooming as well as to demonstrate the performance of the NLS function to reduce respective artifacts. To quantitatively prove HU consistency, HU values were assessed in central ROIs in the clinical cases. In addition, single clinical cases of a hip replacement and pedicle screws in the spine are shown to demonstrate the method's results in other body regions.

RESULTS

The NLS-NMAR can minimize the effect of interpolation-related sinogram inconsistencies and thus reduce resulting hyperdense blooming artifacts. In the phantom results, the reconstructions with the NLS-NMAR-corrected low frequencies demonstrate the lowest error. In the qualitative assessment of the clinical data, the NLS-NMAR shows a tremendous enhancement in image quality, also performing best within all assessed images series.

CONCLUSION

The NLS-NMAR provides a small yet effective extension to conventional NMAR by reducing low-frequency hyperdense metal trace-interpolation-related artifacts in computed tomography.

Mesoporous Silk-Bioactive Glass Nanocomposites as Drug Eluting Multifunctional Conformal Coatings for Improving Osseointegration and Bactericidal Properties of Metal Implants

Endowing metal implants with multifunctional traits to prevent implant-associated infections and improve osseointegration has become a pivotal facet in orthopedics and dental fixation. Herein, we report the synthesis of mesoporous 70S bioactive glass-silk fibroin nanocomposites inspired by the biomimetic organo-apatites of mineralized collagen. The mesoporous, biomimetic nanocomposites enabled loading of antibiotics (gentamicin and doxycycline) and favored their release in a rapid manner while preserving their bioactivity. Ease in modification of the mesoporous nanocomposites enabled tailoring of 3-(aminopropyl)-triethoxysilane to the silanol network of bioactive glass, which improved the loading capacity of the hydrophobic drug (dexamethasone). The modification favored the slow and sustained release of dexamethasone from the modified mesoporous nanocomposites, which is desired for mediating osteogenesis and immunomodulation. Conformal coatings of these drug-loaded nanocomposites were materialized on stainless-steel implants through a facile electrophoretic deposition (EPD) technique, wherein the deposition yield can be controlled by applied parameters. Antibiotic coatings exhibited antibacterial efficacy with bioactivity retained up to 28 days, while dexamethasone-loaded coatings favored mesenchymal stem cell adhesion and osteoinduction. The immunomodulatory roles were also ascertained, wherein M2 macrophage biasness was favored in dexamethasone-loaded coatings. The versatility of these mesoporous biomimetic nanocomposites guarantee the loading of scenario-specific drugs to aid their local delivery through the conformal EPD coatings developed over metal implants toward improving implant patency.

A Novel Technique for Preparation, Staining, and Visualization of Tissue with Metal Implants and Extraskeletal Calcification Areas

The aim of the study was to evaluate the efficacy of a novel technique for preparation, staining, and visualization of tissues containing extra-skeletal mineralization areas, all-metal implants or their prototypes for their subsequent examination using scanning electron microscopy in the backscattered electron mode.

Physicochemical and Biological Properties of Graphene-Oxide-Coated Metallic Materials

In this article, we present graphene oxide (produced by a modified Hummers' method) coatings obtained using two different methods: electrophoretic deposition on 316L stainless steel and chemical modification of the surface of gold applied to the steel. The coating properties were characterized by microscopic and spectrometric techniques. The contact angle was also determined, ranging from 50° to 70°. Our results indicated that GO coatings on steel and gold were not toxic towards L929 cells in a direct cell adhesion test-on all tested materials, it was possible to observe the growth of L929 cells during 48 h of culture. The lack of toxic effect on cells was also confirmed in two viability tests, XTT and MTT. For most of the tested materials, the cell viability was above 70%. They showed that the stability of the coating is the crucial factor for such GO coatings, and prove that GO in the form of coating is non-toxic; however, it can show toxicity if detached from the surface. The obtained materials also did not show any hemolytic properties, as the percentage of hemolysis was on the level of the negative control, which is very promising in the light of future potential applications.

Iatrogenic Iron Promotes Neurodegeneration and Activates Self-Protection of Neural Cells against Exogenous Iron Attacks

Metal implants are used worldwide, with millions of nails, plates, and fixtures grafted during orthopedic surgeries. Iron is the most common element of these metal implants. As time passes, implants can be corroded and iron can be released. Ionized iron permeates the surrounding tissues and enters circulation; importantly, iron ions pass through the blood-brain barrier. Can iron from implants represent a risk factor for neurological diseases? This remains an unanswered question. In this study, we discovered that patients with metal implants delivered through orthopedic surgeries have higher incidence of Parkinson's disease or ischemic stroke compared to patients who underwent similar surgeries but did not have implants. Concentration of serum iron and ferritin was increased in subjects with metal implants. In experiments in vivo, we found that injection of iron dextran selectively decreased the presence of divalent metal transporter 1 (DMT1) in neurons through increasing the expression of Ndfip1, which degrades DMT1 and does not exist in glial cells. At the same time, excess of iron increased expression of DMT1 in astrocytes and microglial cells and triggered reactive astrogliosis and microgliosis. Facing the attack of excess iron, glial cells act as neuroprotectors to accumulate more extracellular iron by upregulating DMT1, whereas neurons limit iron uptake through increasing DMT1 degradation. Cerebral accumulation of iron in animals is associated with impaired cognition, locomotion, and mood. Excess iron from surgical implants thus can affect neural cells and may be regarded as a risk factor for neurodegeneration.

Effects of cobalt and chromium ions on glycolytic flux and the stabilization of hypoxia-inducible factor-1α in macrophages in vitro

Implant wear and corrosion have been associated with adverse tissue reactions that can lead to implant failure. Wear and corrosion products are therefore of great clinical concern. For example, Co²⁺ and Cr³⁺ originating from CoCrMo-based implants have been shown to induce a proinflammatory response in macrophages in vitro. Previous studies have also shown that the polarization of macrophages by some proinflammatory stimuli is associated with a hypoxia-inducible factor-1α (HIF-1α)-dependent metabolic shift from oxidative phosphorylation (OXPHOS) towards glycolysis. However, the potential of Co²⁺ and Cr³⁺ to induce this metabolic shift, which plays a determining role in the proinflammatory response of macrophages, remains largely unexplored. We recently demonstrated that Co²⁺ , but not Cr³⁺ , increased oxidative stress and decreased OXPHOS in RAW 264.7 murine macrophages. In the present study, we analyzed the effects of Co²⁺ and Cr³⁺ on glycolytic flux and HIF-1α stabilization in the same experimental model. Cells were exposed to 6 to 24 ppm Co²⁺ or 50 to 250 ppm Cr³⁺ . Glycolytic flux was determined by analyzing extracellular flux and lactate production, while HIF-1α stabilization was analyzed by immunoblotting. Results showed that Co²⁺ , and to a lesser extent Cr³⁺ , increased glycolytic flux; however, only Co²⁺ acted through HIF-1α stabilization. Overall, these results, together with our previous results showing that Co²⁺ increases oxidative stress and decreases OXPHOS, suggest that Co²⁺ (but not Cr³⁺ ) can induce a HIF-1α-dependent metabolic shift from OXPHOS towards glycolysis in macrophages. This metabolic shift may play an early and pivotal role in the inflammatory response induced by Co²⁺ in the periprosthetic environment.

Effects of Loading Conditions on Articular Cartilage in a Metal-on-Cartilage Pairing

The aim of this in vitro study was to investigate the response of articular cartilage to frictional load when sliding against a metal implant, and identify potential mechanisms of damage to articular cartilage in a metal-on-cartilage pairing. Bovine osteochondral cylinders were reciprocally slid against metal cylinders (cobalt-chromium-molybdenum alloy) with several variations of load and sliding velocity using a microtribometer. The effects of different loads and velocities, and the resulting friction coefficients on articular cartilage, were evaluated by measuring histological and metabolic outcomes. Moreover, the biotribocorrosion of the metal was determined. Chondrocytes stimulated with high load and velocity showed increased metabolic activity and cartilage-specific gene expression. In addition, higher load and velocity resulted in biotribocorrosion of the metal implant and damage to the surface of the articular cartilage, whereas low velocity and a high coefficient of friction increased the expression of catabolic genes. Articular cartilage showed particular responses to load and velocity when sliding against a metal implant. Moreover, metal implants showed tribocorrosion. Therefore, corrosion particles may play a role in the mechano-biochemical wear of articular cartilage after implantation of a metal implant. These findings may be useful to surgeons performing resurfacing procedures and total knee arthroplasty. © 2019 The Authors. Journal of Orthopaedic Research® published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society J Orthop Res 37:2531-2539, 2019.

3D-multi-spectral T2 mapping near metal implants

PURPOSE

Due to host-mediated adverse reaction to metallic debris, there is an increasing need for noninvasive assessment of the soft tissue surrounding large joint arthroplasties. Quantitative T 2 mapping can be beneficial for tissue characterization and early diagnosis of tissue pathology but current T 2 mapping techniques lack the capability to image near metal hardware. A novel multi-spectral T 2 mapping technique is proposed to address this unmet need.

METHODS

A T 2 mapping pulse sequence based on routinely implemented 3D multi-spectral imaging (3D-MSI) pulse sequences is described and demonstrated. The 3D-MSI pulse sequence is altered to acquire images at 2 echo times. Phantom and knee experiments were performed to assess the quantitative capabilities of the sequence in comparison to a commercially available T 2 mapping sequence. The technique was demonstrated for use within a clinical protocol in 2 total hip arthroplasty (THA) cases to assess T 2 variations within the periprosthetic joint space.

RESULTS

The proposed multi-spectral T 2 mapping technique agreed, within experimental errors, with T 2 values derived from a commercially available clinical standard of care T 2 mapping sequence. The same level of agreement was observed in quantitative phantoms and in vivo experiments. In THA cases, the method was able to assess variations of T 2 within the synovial envelope immediately adjacent to implant interfaces.

CONCLUSIONS

The proposed 3D-MSI T 2 mapping sequence was successfully demonstrated in assessing tissue T 2 variations near metal implants.

A numerical and experimental study of RF shimming in the presence of hip prostheses using adaptive SAR at 3 T

PURPOSE

Parallel transmission techniques in MRI have the potential to improve the image quality near metal implants at 3 T. However, current testing of implants only evaluates the risk of radiofrequency (RF) heating in phantoms in circularly polarized mode. We investigate the influence of changing the transmission settings in a 2-channel body coil on the peak temperature near 2 CoCrMo hip prostheses, using adaptive specific absorption rate (SAR) as an estimate of RF heating.

METHODS

Adaptive SAR is a SAR averaging method that is optimized to correlate with thermal simulations and limit the temperature to 39°C near hip implants. The simulated peak temperature was compared when using whole-body SAR, SAR_10g , and adaptive SAR as a constraint for the maximum allowed input power. Adaptive SAR was used as a fast estimate of temperature to evaluate the trade-off between good image quality and low heating near the hip implants. Electromagnetic simulations were validated by simulating and measuring B₁ maps and electric fields in a phantom at 3 T.

RESULTS

Simulations and measurements showed excellent agreement. Limiting whole-body SAR to 2 W/kg and SAR_10g to 10 W/kg resulted in temperatures up to 49.3°C and 40.7°C near the hip implants after 30 minutes of RF exposure, respectively. Predictions based on adaptive SAR limited the temperature to 39°C, and allowed to improve the B₁ field distribution while preventing peak temperatures near the hip implants.

CONCLUSION

Significant RF heating can occur at 3 T near hip implants when parallel transmission is used. Adaptive SAR can be integrated in RF shimming algorithms to improve the uniformity and reduce heating.

Accelerated imaging of metallic implants using model-based nonlinear reconstruction

PURPOSE

To accelerate imaging near metallic implants with multi-spectral imaging (MSI) techniques by exploiting a signal model in the spectral dimension.

METHODS

MSI techniques resolve metal-induced field perturbations by acquiring separate 3D spatial encodings at multiple excitation frequencies, which are referred to as spectral bins. The proposed model-based reconstruction exploits the correlation between spectral bins in image reconstruction by enforcing a signal model to describe the signal profile across bins. This work evaluates the accuracy of the MSI signal model in simulations and in vivo experiments. The proposed model-based reconstruction was evaluated in 6 subjects at an overall undersampling factor of 17.4 and compared with model-free parallel imaging and compressed sensing (PI & CS). The quality of reconstructed images was evaluated using normalized RMS error (nRMSE) and structural similarity index (SSIM) comparisons, with paired Wilcoxon tests in 6 subjects used to determine whether there was a significant difference in the metrics.

RESULTS

Both simulations and in vivo experiments show that the proposed signal model can represent the MSI signal profiles in the spectral dimension compactly and accurately. In the in vivo experiments, the model-based reconstruction significantly improved image quality over model-free PI & CS, with P < 0.05 for both nRMSE and SSIM at 17.4× acceleration.

CONCLUSION

This work presents the feasibility of using a model-based reconstruction to accelerate MSI techniques for faster MR imaging near metal.

Effects of cobalt and chromium ions on oxidative stress and energy metabolism in macrophages in vitro

Cobalt and chromium ions released from cobalt-chromium-molybdenum (CoCrMo)-based implants are a potential health concern, especially since both ions have been shown to induce oxidative stress in macrophages, the predominant immune cells in periprosthetic tissues. Ions of other transition metals (Cd, Ni) have been reported to inhibit the activity of mitochondrial enzymes in the electron transport chain. However, the effects of Co and Cr ions on the energy metabolism of macrophages remain largely unknown. The objective of the present study was to analyze the effects of Co²⁺ and Cr³⁺ on oxidative stress and energy metabolism in macrophages in vitro. RAW 264.7 murine macrophages were exposed to 6-18 ppm Co²⁺ or 50-150 ppm Cr³⁺ . Results showed a significant increase in two markers of oxidative stress, reactive oxygen species level and protein carbonyl content, with increasing concentrations of Co²⁺ , but not with Cr³⁺ . In addition, oxygen consumption rates (OCR; measured using an extracellular flux analyzer) showed significant decreases in both mitochondrial respiration and non-mitochondrial oxygen consumption with increasing concentrations of Co²⁺ , but not with Cr³⁺ . OCR results further showed that Co²⁺ , but not Cr³⁺ , induced mitochondrial dysfunction, including a decrease in oxidative phosphorylation capacity. Overall, this study suggests that mitochondrial dysfunction may contribute to Co²⁺ -induced oxidative stress in macrophages, and thereby to the inflammatory response observed in periprosthetic tissues. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:3178-3187, 2018.

Enhancement of osteoblast activity on nanostructured NiTi/hydroxyapatite coatings on additive manufactured NiTi metal implants by nanosecond pulsed laser sintering

Background

The osteoinductive behaviors of nitinol (NiTi)-based metal implants for bone regeneration are largely dependent on their surface composition and topology. Continuous-mode laser sintering often results in complete melting of the materials and aggregation of particles, which lack control of heat transfer, as well as microstructural changes during sintering of the nanocomposite materials.

Methods

In the current study, in situ direct laser deposition was used to additively manufacture three-dimensional NiTi structures from Ni and Ti powders. The mechanical property of NiTi has been shown to be similar to bone. Nanosecond pulsed laser sintering process was then utilized to generate a nanoporous composite surface with NiTi alloy and hydroxyapatite (HA) by ultrafast laser heating and cooling of Ni, Ti, and HA nanoparticles mixtures precoated on the 3D NiTi substrates; HA was added in order to improve the biocompatibility of the alloy. We then studied the underlying mechanism in the formation of NiTi/HA nanocomposite, and the synergistic effect of the sintered HA component and the nanoporous topology of the composite coating. In addition, we examined the activity of bone-forming osteoblasts on the NiTi/HA surfaces. For this, osteoblast cell morphology and various biomarkers were examined to evaluate cellular activity and function.

Results

We found that the nanoscale porosity delivered by nanosecond pulsed laser sintering and the HA component positively contributed to osteoblast differentiation, as indicated by an increase in the expression of collagen and alkaline phosphatase, both of which are necessary for osteoblast mineralization. In addition, we observed topological complexities which appeared to boost the activity of osteoblasts, including an increase in actin cytoskeletal structures and adhesion structures.

Conclusion

These findings demonstrate that the pulsed laser sintering method is an effective tool to generate biocompatible coatings in complex alloy-composite material systems with desired composition and topology. Our findings also provide a better understanding of the osteoinductive behavior of the sintered nanocomposite coatings for use in orthopedic and bone regeneration applications.

Temperature-sensitive liposomal ciprofloxacin for the treatment of biofilm on infected metal implants using alternating magnetic fields

Implants are commonly used as a replacement for damaged tissue. Many implants, such as pacemakers, chronic electrode implants, bone screws, and prosthetic joints, are made of or contain metal. Infections are one of the difficult to treat complications associated with metal implants due to the formation of biofilm, a thick aggregate of extracellular polymeric substances (EPS) produced by the bacteria. In this study, we treated a metal prosthesis infection model using a combination of ciprofloxacin-loaded temperature-sensitive liposomes (TSL) and alternating magnetic fields (AMF). AMF heating is used to disrupt the biofilm and release the ciprofloxacin-loaded TSL. The three main objectives of this study were to (1) investigate low- and high-temperature-sensitive liposomes (LTSLs and HTSLs) containing the antimicrobial agent ciprofloxacin for temperature-mediated antibiotic release, (2) characterise in vitro ciprofloxacin release and stability and (3) study the efficacy of combining liposomal ciprofloxacin with AMF against Pseudomonas aeruginosa biofilms grown on metal washers. The release of ciprofloxacin from LTSL and HTSL was assessed in physiological buffers. Results demonstrated a lower transition temperature for both LTSL and HTSL formulations when incubated in serum as compared with PBS, with a more pronounced impact on the HTSLs. Upon combining AMF with temperature-sensitive liposomal ciprofloxacin, a 3 log reduction in CFU of Pseudomonas aeruginosa in biofilm was observed. Our initial studies suggest that AMF exposure on metal implants can trigger release of antibiotic from temperature sensitive liposomes for a potent bactericidal effect on biofilm.

Bio-Functional Design, Application and Trends in Metallic Biomaterials

Introduction of metals as biomaterials has been known for a long time. In the early development, sufficient strength and suitable mechanical properties were the main considerations for metal implants. With the development of new generations of biomaterials, the concepts of bioactive and biodegradable materials were proposed. Biological function design is very import for metal implants in biomedical applications. Three crucial design criteria are summarized for developing metal implants: (1) mechanical properties that mimic the host tissues; (2) sufficient bioactivities to form bio-bonding between implants and surrounding tissues; and (3) a degradation rate that matches tissue regeneration and biodegradability. This article reviews the development of metal implants and their applications in biomedical engineering. Development trends and future perspectives of metallic biomaterials are also discussed.

[Research progress of drug-loaded antibacterial coating of orthopedic metal implants]

Objective

To investigate the research progress of drug-loaded antibacterial coating of orthopedic metal implants in recent years.

Methods

The recent literature on the drug-loaded antibacterial coating of orthopedic metal implants were reviewed. The research status, classification, and development trend of drug-loaded antibacterial coating were summarized.

Results

The drug-loaded antibacterial coating of orthopedic metal implants can be divided into passive release type and active release type according to the mode of drug release. Passive drug release coating can release the drug continuously regardless of whether the presence of bacteria around the implants. Active drug release coating do not release the drug unless the presence of bacteria around the implants.

Conclusion

The sustained and stable release of drugs is a key problem to be solved in various antibacterial coatings research. The intelligent antibacterial coating which release antibiotics only in the presence of bacteria is the future direction of development.

Off-resonance based assessment of metallic wear debris near total hip arthroplasty

PURPOSE

The presence of metallic debris near total hip arthroplasty can have a significant impact on longitudinal patient management. Methods for magnetic resonance imaging-based quantification of metallic debris near painful total hip replacements are described and applied to cohorts of symptomatic and control subject cases.

METHODS

A combination of metal artifact reduction, off-resonance mapping, off-resonance background removal, and spatial clustering methods are utilized to quantify off-resonance signatures in cases of suspected metallosis. These methods are applied to a cohort of symptomatic hip arthroplasties composed of cobalt-chromium alloys. Magnetostatic simulations and theoretical principles are used to illuminate the potential sources of the measured off-resonance effects. Reported metrics from histological tissue assays extracted during surgical revision procedures are also correlated with the proposed magnetic resonance imaging-based quantification results.

RESULTS

The presented methods identified quantifiable metallosis signatures in more than 70% of the symptomatic and none of the control cases. Preliminary correlations of the MR data with direct histological evaluation of retrieved tissue samples indicate that the observed off-resonance effect may be related to tissue necrosis.

CONCLUSIONS

Magnetostatic simulations, theoretical principles, and preliminary histological trends suggest that disassociated cobalt is the source of the observed off-resonance signature. Magn Reson Med 79:1628-1637, 2018. © 2017 International Society for Magnetic Resonance in Medicine.

Advances in MRI around metal

The prevalence of orthopedic metal implants is continuously rising in the aging society. Particularly the number of joint replacements is increasing. Although satisfying long-term results are encountered, patients may suffer from complaints or complications during follow-up, and often undergo magnetic resonance imaging (MRI). Yet metal implants cause severe artifacts on MRI, resulting in signal-loss, signal-pileup, geometric distortion, and failure of fat suppression. In order to allow for adequate treatment decisions, metal artifact reduction sequences (MARS) are essential for proper radiological evaluation of postoperative findings in these patients. During recent years, developments of musculoskeletal imaging have addressed this particular technical challenge of postoperative MRI around metal. Besides implant material composition, configuration and location, selection of appropriate MRI hardware, sequences, and parameters influence artifact genesis and reduction. Application of dedicated metal artifact reduction techniques including high bandwidth optimization, view angle tilting (VAT), and the multispectral imaging techniques multiacquisition variable-resonance image combination (MAVRIC) and slice-encoding for metal artifact correction (SEMAC) may significantly reduce metal-induced artifacts, although at the expense of signal-to-noise ratio and/or acquisition time. Adding advanced image acquisition techniques such as parallel imaging, partial Fourier transformation, and advanced reconstruction techniques such as compressed sensing further improves MARS imaging in a clinically feasible scan time. This review focuses on current clinically applicable MARS techniques. Understanding of the main principles and techniques including their limitations allows a considerate application of these techniques in clinical practice. Essential orthopedic metal implants and postoperative MR findings around metal are presented and highlighted with clinical examples.

LEVEL OF EVIDENCE

4 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2017;46:972-991.

Improved field-mapping and artifact correction in multispectral imaging

PURPOSE

To develop a method for improved B₀ field-map estimation, deblurring, and image combination for multispectral imaging near metal.

METHODS

A goodness-of-fit field-map estimation technique is proposed that uses only the multispectral imaging (MSI) data to estimate the field map. Using the improved field map, a novel deblurring technique is proposed that also employs a new image combination scheme to reduce the effects of noise and other residual MSI artifacts. The proposed field-map estimation and deblurring techniques are compared to the current methods in phantoms and/or in vivo from subjects with knee, hip, and spinal metallic implants.

RESULTS

Phantom experiments validate that the goodness-of-fit field-map estimation is less sensitive to noise and bias than the conventional center-of-mass technique, which reduces distortion in the deblurring methods. The new deblurring approach also is substantially less sensitive to noise and distortion than the current deblurring method, as demonstrated in phantoms and in vivo, and is able to find a good tradeoff between deblurring and distortion.

CONCLUSION

The proposed methods not only enable field-mapping with reduced noise sensitivity but are able to create deblurred images with less distortion and better signal-to-noise ratio with no additional scan time, thereby enabling improved visualization of underlying anatomy near metallic implants. Magn Reson Med 78:2022-2034, 2017. © 2017 International Society for Magnetic Resonance in Medicine.

P2 porous titanium implants improve tendon healing in an acute rat supraspinatus repair model

BACKGROUND

Current techniques in rotator cuff repair often lack structural integrity. P² porous titanium-coated constructs (DJO Surgical, Austin, TX, USA) promote osseointegration and soft tissue ingrowth. This study examined the ability of this material to improve the structural integrity of supraspinatus tendon repair in a rat model. We hypothesized that P² implants placed at the tendon-to-bone interface would improve mechanical and histologic measures of supraspinatus healing.

METHODS

Forty rats underwent supraspinatus repairs with P² implants in 1 shoulder and standard repair in the other. Rats were humanely killed at time 0 (n = 3), 2 weeks (n = 8), 4 weeks (n = 15), and 12 weeks (n = 14). Tendon-to-bone composite specimens were harvested and evaluated mechanically and histologically.

RESULTS

Tendon cross-sectional area was decreased in the P² implant group at 4 weeks, percentage of relaxation was increased at 2 weeks, elastic modulus was increased at 4 weeks, and maximum load and maximum stress were both increased at 2 and 4 weeks. Histologic analysis revealed no foreign body reactions within or around the P² implant, and healthy viable bone was visible within the P² implant.

CONCLUSION

The results support our hypothesis, specifically in early healing, in this randomized controlled animal study. These data support the use of P² porous titanium implants to improve tendon-to-bone healing.

Metallic implant geometry and susceptibility estimation using multispectral B0 field maps

PURPOSE

To estimate the susceptibility and the geometry of metallic implants from multispectral imaging (MSI) information, to separate the metal implant region from the surrounding signal loss region.

THEORY AND METHODS

The susceptibility map of signal-void regions is estimated from MSI B₀ field maps using total variation (TV) regularized inversion. Voxels with susceptibility estimates above a predetermined threshold are identified as metal. The accuracy of the estimated susceptibility and implant geometry was evaluated in simulations, phantom, and in vivo experiments.

RESULTS

The proposed method provided more accurate susceptibility estimation compared with a previous method without TV regularization, in both simulations and phantom experiments. In the phantom experiment where the actual implant was 40% of the signal-void region, the mean estimated susceptibility was close to the susceptibility in literature, and the precision and recall of the estimated geometry was 85% and 93%. In vivo studies in subjects with hip implants also demonstrated that the proposed method can distinguish implants from surrounding low-signal tissues, such as cortical bone.

CONCLUSION

The proposed method can improve the delineation of metallic implant geometry by distinguishing metal voxels from artificial signal voids and low-signal tissues by estimating the susceptibility maps. Magn Reson Med 77:2402-2413, 2017. © 2016 International Society for Magnetic Resonance in Medicine.

Flexible longitudinal magnetization contrast in spectrally overlapped 3D-MSI metal artifact reduction sequences: Technical considerations and clinical impact

PURPOSE

It has previously been demonstrated that increased overlap of spectral bins in three-dimensional multispectral imaging techniques (3D-MSI) can aid in reducing residual artifacts near metal implants. However, increasing spectral overlap also necessitates consideration of saturation effects for species with long T1 values. Here, an interleaved spectral bin acquisition strategy is presented for overlapping 3D-MSI that allows for flexible choice of repetition times while simultaneously addressing these cross talk concerns.

METHODS

A phantom imaging experiment is used to illustrate the amplified effect of cross talk on 3D-MSI acquisitions. A methodological approach to address cross talk across a variety of prescribed repetition times is then described. Using the presented principles, a clinical subject with a total hip replacement was imaged to generate T1, proton density, and short-tau inversion recovery contrasts. In addition, a fracture instrumentation case was imaged pre- and postcontrast using T1-weighted spectrally overlapped 3D-MSI.

RESULTS

Phantom results demonstrate that conventional spectral interleaving approaches can generate unwanted signal characteristics in heavily overlapped 3D-MSI. Clinical images using the presented methods successfully demonstrate T1, proton density, and inversion recovery image contrasts using heavily overlapped 3D-MSI.

CONCLUSIONS

Through automated management of spectral bin distributions across multiple interleaves, a variety of longitudinal magnetization contrasts can efficiently be acquired without any clinically relevant cross-talk impact using heavily overlapped 3D-MSI.

Off-resonance suppression for multispectral MR imaging near metallic implants

PURPOSE

Metal artifact reduction in MRI within clinically feasible scan-times without through-plane aliasing.

THEORY AND METHODS

Existing metal artifact reduction techniques include view angle tilting (VAT), which resolves in-plane distortions, and multispectral imaging (MSI) techniques, such as slice encoding for metal artifact correction (SEMAC) and multi-acquisition with variable resonances image combination (MAVRIC), that further reduce image distortions, but significantly increase scan-time. Scan-time depends on anatomy size and anticipated total spectral content of the signal. Signals outside the anticipated spatial region may cause through-plane back-folding. Off-resonance suppression (ORS), using different gradient amplitudes for excitation and refocusing, is proposed to provide well-defined spatial-spectral selectivity in MSI to allow scan-time reduction and flexibility of scan-orientation. Comparisons of MSI techniques with and without ORS were made in phantom and volunteer experiments.

RESULTS

Off-resonance suppressed SEMAC (ORS-SEMAC) and outer-region suppressed MAVRIC (ORS-MAVRIC) required limited through-plane phase encoding steps compared with original MSI. Whereas SEMAC (scan time: 5'46") and MAVRIC (4'12") suffered from through-plane aliasing, ORS-SEMAC and ORS-MAVRIC allowed alias-free imaging in the same scan-times.

CONCLUSION

ORS can be used in MSI to limit the selected spatial-spectral region and contribute to metal artifact reduction in clinically feasible scan-times while avoiding slice aliasing.