Magnetic resonance imaging of metal artifact reduction sequences in the assessment of metal-on-metal hip prostheses
Sharief M Aboelmagd, Paul N Malcolm, Andoni P Toms
Department of Radiology, Norfolk and Norwich University Hospital National Health Service Trust, Norwich, UK
Abstract: Recent developments in metal artifact reduction techniques in magnetic resonance (MR) have, in large part, been stimulated by the advent of soft tissue complications associated with modern metal-on-metal total hip replacements. Metallic orthopedic implants can result in severe degradation of MR images because ferromagnetic susceptibility causes signal loss, signal pile-up, geometric distortion, and failure of fat suppression. There are several approaches to controlling these susceptibility artifacts. Standard fast spin echo sequences can be adapted by modifying echo times, matrix, receiver bandwidth, slice thickness, and echo trains to minimize frequency encoding misregistration. Short tau inversion recovery and 2-point Dixon techniques are both more resistant to susceptibility artifacts than spectral fat suppression. A number of dedicated metal artifact reduction sequences are now available commercially. The common approach of these multispectral techniques is to generate three dimensional datasets from which the final images are reconstructed. Frequency encoding misregistration is controlled using a variety of techniques, including specific resonant frequency acquisition, view-angle tilting, and phase encoding. Metal artifact reduction MR imaging has been the key to understanding the prevalence, severity, and prognosis of adverse reactions to metal debris in metal-on-metal hip replacements. Conventional radiographs are typically normal or demonstrate minimal change and are unable to demonstrate the often extensive soft tissue abnormalities, which include necrosis, soft tissue masses and fluid collections, myositis, muscle atrophy, tendon avulsions, and osteonecrosis. These MR findings correlate poorly with clinical and serological measures of disease, and therefore MR imaging is the principal tool for the diagnosis of soft tissue disease and surveillance in metal-on-metal hip replacements.
Keywords: MRI, artifact, hip, arthroplasty, soft tissue
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