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Magnetresonanztomographische Untersuchungen bei Problemen mit Metall-auf-Metall-Implantaten

MRI investigations in patients with problems due to metal-on-metal implants

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An Erratum to this article was published on 12 January 2014

Abstract

Until recently, metal-on-metal (MoM) hip implants were commonly used for joint replacement and resurfacings. Their use has rapidly declined following reports of Frühversagen and soft tissue disease caused by the release of metal debris from the prosthesis. Detection of these soft tissue lesions has proven difficult using conventional imaging techniques and blood metal ion tests. Current guidelines recommend the use of imaging modalities including metal artefact reduction sequence (MARS) magnetic resonance imaging (MRI), computed tomography and ultrasound but provide little indication which is best. MARS significantly reduces the susceptibility artefact induced by the presence of metal objects, thereby producing diagnostic quality images that can be shared with other physicians and compared over time. The clinical interpretation of MRI findings of solid pseudotumours and severe muscle atrophy is straightforward: revision is usually recommended. However, the most common MRI findings are of a cystic pseudotumour and minor muscle wasting. In these cases decision-making is difficult and we currently use multi-disciplinary and multi-colleague based meetings to make decisions regarding patient management. This article presents a comparison of imaging modalities and an update on the interpretation of MARS MRI for the investigation of patients with MoM hip implants.

The English full-text version of this article is available at Springer Link (under “Supplemental”).

Zusammenfassung

Bis vor kurzem kamen Metall-Metall(MoM)-Gleitpaarungen in der Hüftendoprothetik regelmäßig zur Anwendung. Nach Berichten über Frühversagen und Weichteilschädigungen durch Metallabrieb hat ihr Einsatz schnell und stark abgenommen. Das Ausmaß der Weichteilschädigungen ist durch konventionelle radiologische Bildgebung und Metallionenbestimmung nur schwer zu bestimmen. In aktuellen Richtlinien werden Metallartefaktreduzierte Sequenzen (MARS) in der Magnetresonanztomographie (MRT), Computertomographie (CT) und Ultraschall empfohlen, zur Wertigkeit werden kaum Anhaltspunkte gegeben. MARS reduzieren die metallinduzierten Suszeptibilitätsartefakte deutlich und erzeugen klarere Bilder, die mehrfach befundet und im zeitlichen Verlauf beurteilt werden können. Die klinische Interpretation magnetresonanztomographisch sichtbarer solider Pseudotumoren und schwerer Muskelschädigungen ist unkompliziert, in der Regel wird eine operative Revision empfohlen. Doch die häufigsten MRT-Befunde sind zystische Pseudotumoren und diskrete Muskelatrophien. Dann ist die Entscheidungsfindung schwierig, und das weitere Vorgehen wird in multidisziplinären Sitzungen von mehreren Medizinern besprochen. Der Beitrag vergleicht bildgebende Verfahren und gibt ein Update zur Interpretation der MARS-MRT-Aufnahmen von MoM-Hüftendoprothesen.

Die englische Originalversion dieses Beitrags steht auf SpringerLink (unter „Supplement“) zur Verfügung.

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  43. Tab. 1

  44. Klassifikation der fettigen Muskeldegeneration. (Nach Goutallier et al. [15])

  45. Grad

  46. Charakteristik

  47. Prozentualer Anteil Fett (MRT; in %)

  48. 0

  49. Normale Muskulatur

  50. 0

  51. 1

  52. Muskulatur mit einigen Fettstreifen

  53. bis 25

  54. 2

  55. Deutliche fettige Infiltration mit mehr Muskulatur als Fett

  56. 26 bis 49

  57. 3

  58. Deutliche fettige Infiltration mit gleich viel Muskulatur wie Fett

  59. 50

  60. 4

  61. Ausgeprägte fettige Infiltration mit weniger Muskulatur als Fett

  62. mehr als 50999

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Interessenkonflikt

Der korrespondierende Autor weist für sich und seine Koautoren auf folgende Beziehung/en hin: AH berät Depuy zum klinischen Assessment von Patienten mit MoM-Hüftendoprothesen. KS ist Mitglied in einer für Johnson und Johnson tätigen Kommission.

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Hart, A. Magnetresonanztomographische Untersuchungen bei Problemen mit Metall-auf-Metall-Implantaten. Orthopäde 42, 629–636 (2013). https://doi.org/10.1007/s00132-012-2036-2

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