title: Detection of metallic cobalt and chromium liver deposition following failed hip replacement using T2* and R2 magnetic resonance.
abstract: Failed hip prostheses can cause elevated circulating cobalt and chromium levels, with rare reports of fatal systemic organ deposition, including cobalt cardiomyopathy. Although blood cobalt and chromium levels are easily measured, organ deposition is difficult to detect without invasive biopsy. The T2* magnetic resonance (MR) method is used to quantify tissue iron deposition, and plays an important role in the management of iron-loading conditions. Cobalt and chromium, like iron, also affect magnetism and are proposed MR contrast agents.
  
  
  
  We describe a case of a 44-year-old male with a failed hip implant and very elevated blood cobalt and chromium levels. Despite normal cardiac MR findings, liver T2* and R2 values were abnormal, triggering tissue biopsy. Liver tissue analysis, including X-ray fluorescence, demonstrated heavy elemental cobalt and chromium deposition in macrophages, and no detectable iron.
  
  
  
  Our case demonstrates T2* and R2 quantification of liver metal deposition in a patient with a failed hip implant. Further work is needed to investigate the role of T2* and R2 MR in the detection of metal deposition from metal on metal hip prostheses.
authors.affiliation: Institute of Cardiovascular Science, University College London, London, UK.|Barts Heart Centre, St. Bartholomew's Hospital, London, UK.
authors.forename: Amna
authors.initials: A
authors.lastname: Abdel-Gadir
authors.affiliation: Royal National Orthopedic Hospital, Stanmore, UK.
authors.forename: Reshid
authors.initials: R
authors.lastname: Berber
authors.affiliation: Department of Hematology, University College London, London, UK.
authors.forename: John B
authors.initials: JB
authors.lastname: Porter
authors.affiliation: Diamond Light Source, Harwell Science and Innovation Campus, Didcot, UK.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Quinn
authors.affiliation: Department of Gastroenterology, The Whittington Hospital, London, UK.
authors.forename: Deepak
authors.initials: D
authors.lastname: Suri
authors.affiliation: Medical Signal and Image Processing Program, National Heart, Lung, and Blood Institute, Bethesda, MD, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Kellman
authors.affiliation: Royal National Orthopedic Hospital, Stanmore, UK.
authors.forename: Alister J
authors.initials: AJ
authors.lastname: Hart
authors.affiliation: Institute of Cardiovascular Science, University College London, London, UK.|Barts Heart Centre, St. Bartholomew's Hospital, London, UK.
authors.forename: James C
authors.initials: JC
authors.lastname: Moon
authors.affiliation: Institute of Cardiovascular Science, University College London, London, UK. c.manisty@ucl.ac.uk.|Barts Heart Centre, St. Bartholomew's Hospital, London, UK. c.manisty@ucl.ac.uk.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Manisty
authors.affiliation: Royal National Orthopedic Hospital, Stanmore, UK.
authors.forename: John A
authors.initials: JA
authors.lastname: Skinner
mesh_terms: D000328:Adult; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000295:instrumentation*; D001706:Biopsy; D002858:Chromium Alloys / Q000378:metabolism; D006622:Hip Prosthesis; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging* / Q000378:metabolism; D008279:Magnetic Resonance Imaging; D008297:Male; D061825:Metal-on-Metal Joint Prostheses; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D011475:Prosthesis Failure; D013052:Spectrometry, X-Ray Emission; D014018:Tissue Distribution
chemical_list: D002858:Chromium Alloys
keywords: Chromium; Cobalt; MRI; Metal loading; Metal-on-metal hip; T2*