Metallic artifact suppression with MAVRIC-SL in magnetic resonance imaging for assessing chronic pain after hip or knee arthroplasty

Rios, Gustavo Mota; Lins, Carolina Freitas; Quadros Junior, Milson Carvalho; Nery, Raphaela Lisboa Andrade; Trindade, Ronald Meira Castro; Matos, Marcos Almeida

doi:10.1590/0100-3984.2023.0026

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Original Article • Radiol Bras 56 (5) • Sep-Oct 2023 • https://doi.org/10.1590/0100-3984.2023.0026 copy

Metallic artifact suppression with MAVRIC-SL in magnetic resonance imaging for assessing chronic pain after hip or knee arthroplasty

Supressão do artefato metálico na ressonância magnética com MAVRIC-SL na avaliação da dor crônica em artroplastia de quadril ou joelho

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To analyze the association between osteolysis at the prosthesis interfaces, as determined by magnetic resonance imaging (MRI) with multiacquisition variable-resonance image combination selective (MAVRIC-SL) sequences, and clinical severity after knee or hip arthroplasty, as well as to assess interobserver and intraobserver agreement on periprosthetic bone resorption.

Materials and Methods:

This was a cross-sectional study of 47 patients (49 joints) under postoperative follow-up after knee or hip arthroplasty, with chronic pain, between March 2019 and August 2020. All of the patients completed the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire. The component interfaces were evaluated and ordered into two groups: osseointegrated and osteolytic. Nonparametric tests were used.

Results:

There were significant differences between the two groups in terms of the mean WOMAC scores: total (p = 0.010); stiffness domain (p = 0.047); and function (p = 0.011) domains. There was substantial interobserver and intraobserver agreement for most analyses of the components.

Conclusion:

Periprosthetic osteolysis appears to be associated with clinical complaints of pain in the post-arthroplasty scenario, and MAVRIC-SL provides reproducible assessments. It could prove to be an important tool for orthopedists to use in the evaluation of challenging cases of chronic pain after arthroplasty.

Keywords:
Magnetic resonance imaging; Arthroplasty; Osteolysis; Arthralgia; Prosthesis failure

Parameter	MRI with MAVRIC-SL sequences
Parameter	Coronal STIR	Axial STIR	Axial T1-weighted	Axial T1-weighted CE	Sagittal PD
TR (ms)	4000-5000	4000-5000	300-700	300-700	3000
TE (ms)	7.4	7.2	7.9	7.9	6.6
TI (ms)	150	150	-	-	-
Echo train (Hz/pixel)	20	20	8	8	20
Slice thickness (mm)	5.0	5.0	6.0	6.0	4.0
Interslice gap (mm)	0.0	0.0	0.0	0.0	0.0
FOV	38 × 38	26 × 20	32 × 28	32 × 28	40 × 32
Matrix	256 × 192	256 × 192	320 × 224	320 × 224	384 × 256
Bandwidth	125 kHz	125 kHz	125 kHz	125 kHz	125 kHz
NEX	0.50	0.50	0.50	0.50	0.50

Parameter	MRI with MAVRIC-SL sequences
Parameter	Coronal STIR	Axial STIR	Axial T1-weighted	Axial T1-weighted CE	Sagittal PD
TR (ms)	4000-6000	4000-6000	300-700	300-700	3700
TE (ms)	6.8	7.0	7.4	7.4	7.8
TI (ms)	150	150	-	-	-
Echo train (Hz/pixel)	20	20	8	8	20
Slice thickness (mm)	4.0	5.0	5.0	5.0	4.0
Interslice gap (mm)	0.0	0.0	0.0	0.0	0.0
FOV	22 × 17	22 × 17	22 × 17	22 × 17	18 × 14
Matrix	256 × 192	256 × 192	320 × 192	320 × 192	320 × 256
Bandwidth	125 kHz	125 kHz	125 kHz	125 kHz	125 kHz
NEX	0.50	0.50	0.50	0.50	0.50

Characteristic	Osseointegrated (n)	Osteolytic (n)	Total n (%)	P ^* * Pearson’s chi-square test.
Age (years)				0.49
≤ 59	2	7	9 (18.4)
> 59	12	28	40 (81.6)
Gender				0.61
Female	11	27	38 (77.5)
Male	3	8	11 (22.5)
Race				0.20
Black	2	10	12 (24.5)
White	1	7	8 (16.3)
Indigenous	0	2	2 (4.1)
Mixed	11	16	27 (55.1)
Time since surgery				0.16
3-5 months	5	7	12 (24.5)
6-12 months	1	10	11 (22.5)
13-18 months	3	3	6 (12.2)
19-24 months	0	5	5 (10.2)
> 24 months	5	10	15 (30.6)
Time since pain onset				0.16
3-5 months	4	11	15 (30.6)
6-12 months	6	14	20 (40.8)
13-18 months	3	1	4 (8.2)
19-24 months	0	5	5 (10.2)
> 24 months	1	4	5 (10.2)
Body mass index				0.032 ^† † Statistically significant.
Normal	2	6	8 (16.3)
Overweight	3	15	18 (36.7)
Obesity class I	6	14	20 (40.8)
Obesity class II	3	0	3 (6.2)
Underlying cause
Osteoarthritis	14	29	43 (87.8)	0.43
Osteonecrosis	0	1	1 (2.0)
Trauma	0	2	2 (4.1)
Other	0	3	3 (6.1)
Visual analogue scale				0.81
0-2	1	2	3 (6.1)
3-7	6	12	18 (36.7)
8-10	7	21	28 (57.2)

WOMAC score	Periprosthetic osteolysis		P ^* * Mann-Whitney U test.
WOMAC score	Yes (n = 26)	No (n = 23)	P ^* * Mann-Whitney U test.
Total	29.92	19.43	0.010 ^† † Statistically significant.
By domain
Pain	28.62	20.91	0.059
Stiffness	28.38	21.17	0.047 ^† † Statistically significant.
Function	29.90	19.46	0.011 ^† † Statistically significant.

Finding			Joints n (%)
In TKA
Cement extravasation into soft tissues			1 (3.1)
Pes anserine bursitis			3 (9.4)
Baker cyst (with rupture or loose bodies)			4 (12.5)
Cyst in periarticular soft tissues			1 (3.1)
Microfracture of the bone trabeculae in the medial tibial condyle			1 (3.1)
Deep infrapatellar bursitis			2 (6.2)
Bursitis of the medial collateral ligament			1 (3.1)
Semimembranosus bursitis			1 (3.1)
Limb length discrepancy			3 (9.4)
In THA
Small fluid collection in the deep subcutaneous tissue			1 (5.9)
Trochanteric bursitis			3 (17.6)
Cement extravasation into soft parts of the pelvis			1 (5.9)
Pseudotumor			3 (17.6)
Limb length discrepancy			2 (13.3)

Agreement analyzed	Site	Cohen’s kappa	P ^* * Kappa test.
Interobserver THA	Acetabulum	0.72	0.047 ^† † Statistically significant.
	Femur	0.77	0.001 ^† † Statistically significant.
TKA	Femur	0.33	0.104
	Tibia	0.72	< 0.001^† † Statistically significant.
	Patella	0.50	0.248
Intraobserver THA	Acetabulum	0.57	0.031 ^† † Statistically significant.
	Femur	0.64	0.008 ^† † Statistically significant.
TKA	Femur	0.76	< 0.001^† † Statistically significant.
	Tibia	0.62	< 0.001^† † Statistically significant.
	Patella	0.50	0.248

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[1] Correspondence: Dr. Gustavo Mota Rios. Delfin Medicina Diagnóstica. Avenida Antônio Carlos Magalhães, 442, Pituba. Salvador, BA, Brazil, 41800-700. Email: gmrios@yahoo.com.br.