title: Cross-sectional imaging of metal-on-metal hip arthroplasties. Can we substitute MARS MRI with CT?
abstract: OBJECTIVE
  Metal artifact reduction sequence (MARS) MRI is widely advocated for surveillance of metal-on-metal hip arthroplasties (MOM-HAs). However, its use is limited by susceptibility artifact at the prosthesis-bone interface, local availability, patient compliance, and cost (Hayter et al. 2011a). We wanted to determine whether CT is a suitable substitute for MARS MRI in evaluation of the painful MOM-HA.
  
  
  METHODS
  50 MOM-HA patients (30 female) with unexplained painful prostheses underwent MARS MRI and CT imaging. 2 observers who were blind regarding the clinical data objectively reported the following outcomes: soft tissue lesions (pseudotumors), muscle atrophy, and acetabular and femoral osteolysis. Diagnostic test characteristics were calculated.
  
  
  RESULTS
  Pseudotumor was diagnosed in 25 of 50 hips by MARS MRI and in 11 of 50 by CT. Pseudotumors were classified as type 1 (n=2), type 2A (n=17), type 2B (n=4), and type 3 (n=2) by MARS MRI. CT did not permit pseudotumor classification. The sensitivity of CT for diagnosis of pseudotumor was 44% (95% CI: 25-65). CT had "slight" agreement with MARS MRI for quantification of muscle atrophy (κ=0.23, CI: 0.16-0.29; p<0.01). Osteolysis was identified in 15 of 50 patients by CT. 4 of these lesions were identified by MARS MRI.
  
  
  CONCLUSIONS
  CT was found to be superior to MRI for detection of osteolysis adjacent to MOM-HA, and should be incorporated into diagnostic algorithms. CT was unable to classify and failed to detect many pseudotumors, and it was unreliable for assessment of muscle atrophy. Where MARS MRI is contraindicated or unavailable, CT would be an unsuitable substitute and other modalities such as ultrasound should be considered.
authors.affiliation: Institute of Musculoskeletal Science, UCL, London.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Robinson
authors.forename: Johann
authors.initials: J
authors.lastname: Henckel
authors.forename: Shiraz
authors.initials: S
authors.lastname: Sabah
authors.forename: Keshthra
authors.initials: K
authors.lastname: Satchithananda
authors.forename: John
authors.initials: J
authors.lastname: Skinner
authors.forename: Alister
authors.initials: A
authors.lastname: Hart
mesh_terms: D000328:Adult; D000465:Algorithms; D018771:Arthralgia / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000295:instrumentation*; D016477:Artifacts; D005260:Female; D005500:Follow-Up Studies; D006104:Granuloma, Plasma Cell / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods / Q000706:statistics & numerical data; D008297:Male; D061825:Metal-on-Metal Joint Prostheses / Q000009:adverse effects*; D008875:Middle Aged; D009133:Muscular Atrophy / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D015588:Observer Variation; D010014:Osteolysis / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology*; D014057:Tomography, X-Ray Computed / Q000379:methods / Q000706:statistics & numerical data