Artikel
MRI versus SPECT/CT in painful hip arthroplasty
Suche in Medline nach
Autoren
-
Henrik Bäcker
- Luzerner Kantonsspital, Klinik für Radiologie und Nuklearmedizin, Klinik für Orthopädie und Unfallchirurgie, Luzern, Switzerland
-
Isabelle Steurer-Dober
- Institut für Radiologie, Baar, Switzerland
-
Martin Beck
- Luzerner Kantonsspital, Klinik für Orthopädie und Unfallchirurgie, Luzern, Switzerland
-
Jens Decking
- Klinik für Orthopädie Sursee, Sursee, Switzerland
-
Richard Herzog
- Klinik für Orthopädie Wolhusen, Wolhusen, Switzerland
-
Klaus Strobel
- Luzerner Kantonspital, Klinik für Radiologie und Nuklearmedizin, Luzern, Switzerland
| Veröffentlicht: | 6. November 2018 |
|---|
Gliederung
Text
Objectives: Many patients after hip arthroplasty develop pain for different reasons (aseptic loosening, malposition, infection, tendon friction, foreign body reaction, bursitis). MR with metal artifact reduction and SPECT/CT are increasingly used to image painful hip arthroplasties. To investigate the value of MRI in comparison to SPECT-CT in patients with painful hip arthroplasty.
Methods: In this prospective study 36 patients (mean age 62 years, range 32-83y) were imaged between 2015 and December 2017. In total, 3 patients had to be excluded because of non-diagnostic imaging quality (1 MRI and 2 SPECT-CT). MR images were reviewed by a musculoskeletal radiologist and SPECT/CT by a doubly certified radiologist and nuclear medicine physician. Impact of imaging on the final diagnosis was assessed. Final diagnosis was established by an experienced hip surgeon by integration of all imaging information together with detailed clinical examination.
Results and conclusion: The quality of the MRI was good in 62.2%, fair in 35.1% and not diagnostic in 0.3%. In MRI, 18 prosthesis loosening were identified in 17 patients (12 shaft loosening and 6 cup loosening) and infection in one patient. With SPECT-CT, in 13 patients loosening (7 shaft loosening and 6 cup loosening) was diagnosed and 3 infections. Final diagnosis was loosening in 16 cases (9 cups and 7 shafts in 13 patients) and infection in 3 cases. In 14 cases surgery was indicated to change either cup (6 patients) or shaft (1 patient) or both (7 patients). In 3 further cases operative surgery for closure of the iliotibial tract, hip-arthroscopy or tumor resection was indicated. There was a concordant diagnosis with SPECT/CT and MR in 11 patients. In 2 cases shaft loosening could not be excluded. Soft tissue problems could be identified in 13 patients (7 suffered from bursitis and 7 from an insertion tendinitis).
According to the orthopedic surgeon, MRI was more decisive than SPECT/CT in 17 cases, SPECT-CT more than MR in 5 cases. No difference in the informative value between MRI and SPECT-CT were observed in 14 patients. It seems, MR imaging is a good alternative for SPECT-CT in painful hip arthroplasty.
