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DOI: 10.1055/s-0045-1802970
Reliability of Slice-Encoding for Metal Artifact Correction (SEMAC) MRI to Identify Prosthesis Loosening in Patients with Painful Knee Arthroplasty: A Prospective, Single-Center, Surgical Validation Study
Funding This article presents independent research supported by the National Institute for Health Research (NIHR) Leeds Biomedical Research Centre (BRC) (R&D Number: RR12/10615 and REC: 12/YH/0555).
Abstract
Objectives To validate reliability of slice-encoding for metal artifact correction (SEMAC) sequences in identifying prosthesis loosening in patients with painful knee arthroplasties (KAs) by comparing SEMAC-magnetic resonance imaging (MRI) findings to surgical outcomes—the gold standard.
Materials and Methods We prospectively followed 44 painful KA patients with possible aseptic prosthesis loosening at our tertiary care institution from 2011 to 2017. Potential cases of infective loosening were excluded making ours a selective study population. We acquired conventional and SEMAC-MRI images for all patients on 1.5-T MRI scanner. Two consultants scored MRI findings for complications such as osteolysis and bone marrow edema systematically. Scoring variations were settled by consensus. We used the Mann–Whitney U test and Wilcoxon signed-rank test for quantitative analysis and Spearman's rank-order correlation for correlation analysis of SEMAC findings and surgical outcomes, and followed the Outcome Measurements in Rheumatology filter methodology to assess the ability of SEMAC-MRI to detect prosthetic loosening.
Results Eleven patients needed revision surgery—seven had prosthesis loosening and four had retained native compartment osteoarthritis. Thirty-three were treated conservatively, of which 17 had spontaneous pain resolution and 8 had extra-articular causes—referred pain from hip (1 patient) and lumbar (7 patients) degeneration. Eight patients had adequate pain control without prosthesis loosening on follow-up. T1W-SEMAC identified surgically proven prosthesis loosening in all cases and short tau inversion recovery (STIR)-SEMAC diagnosed bone marrow edema (BME) in all our true positive cases. Sensitivity, specificity, positive predictive value, and negative predictive value of SEMAC-MRI for component loosening compared with gold standard were 100, 97.0, 88.9, and 100% in T1W-SEMAC, 75.0, 45.5, 25.0, and 88.2% in STIR-SEMAC, and 75.0, 93.9, 75.0, and 93.9% in proton density-weighted-SEMAC.
Conclusion SEMAC-MRI can accurately detect surgically verifiable prosthesis loosening and differentiate nonspecific BME from prosthesis loosening.
Authors' Contributions
T.T.: Data collection, analysis, and manuscript preparation.
S.T.: Manuscript preparation and editing, image editing, and submission.
G.L.: Data collection.
A.R.: Study supervision, data collection, and review.
M.R.B.: Study design, ethics, data collection, and analysis.
M.S.: Study supervision, review, and modification.
H.P.: Study design, surgical quality control, manuscript review, and editing.
P.O.C.: Concept, study design, data collection, manuscript editing, and submission.
Registration and Grant Number
None.
Publikationsverlauf
Artikel online veröffentlicht:
25. Februar 2025
© 2025. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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