Multi-energy spectral photon-counting computed tomography (MARS) for detection of arthroplasty implant failure

Abstract

To determine whether state-of-the-art multi-energy spectral photon-counting computed tomography (MARS) can detect knee arthroplasty implant failure not detected by standard pre-operative imaging techniques. A total knee arthroplasty (TKA) removed from a patient was reviewed. The extracted prosthesis [NexGen Legacy Posterior Stabilized (LPS) TKA] was analyzed as were pre-operative imaging examination and compared with a MARS-CT examination obtained of the extracted TKA prosthesis. Radiographs, fluoroscopy, ultrasound and MRI preoperatively did not reveal the cause of the implant failure. MARS CT images of the extracted prosthesis clearly showed the presence of posteromedial polyethylene and tibial tray wear which is compatible with the clinical appearance of the extracted TKA. MARS can identify polyethylene insert and metallic tibial tray wear as a cause of TKA failure, that could not be identified with on standard pre-operative imaging. Although clinical MARS CT system is still under development, this case does illustrate its potential clinical usefulness. This is the first study to document how MARS CT imaging can detect orthopedic implant failure not detected by standard current imaging techniques. This system has a potential clinical application in orthopedic patients.

A novel image-based machine learning model with superior accuracy and predictability for knee arthroplasty loosening detection and clinical decision making

“…With the ever-growing number of TKA being performed, this further implies a likely increase on the number of follow-up cases and patients living with TKA. Despite the advancement of surgical techniques (e.g., use of robot and navigation), some centers have begun to offer lifelong follow-ups for these patients in considering the likelihood on the occurrence of common complications, such as loosening, fracture and wearing, to appear after many years of TKA [ 3 , [13] , [14] , [15] , [16] , [31] ]. This post TKA follow-ups have significant burden to the healthcare systems given the late occurrence of loosening and cumulative increase on the number of patients living with TKA.…”

Avulsion Fracture of Bicruciate Ligament and Patellar Tendon in Bicruciate-Retaining Total Knee Arthroplasty

“…5 ). Other relevant details such as the status of polyethylene insert and the integrity of the ACL and PCL could not be evaluated with DECT, though other upcoming imaging modalities such as multienergy spectral photon-counting computed tomography (MARS CT) may be helpful in identifying these failures due to a superior material composition differentiating power [ 17 ].…”

Dual-Energy Computed Tomography for Evaluation of Breast Cancer Follow-Ups: Comparison of Virtual Monoenergetic Images and Iodine-Map

“…However, these approaches may require patients to be prospectively selected for DECT. In the latest generation, multiple energy spectral photon counting DECT systems use a dual-layer detector [22,23] to capture the characteristic attenuation of different materials at multiple energy spectrums, with the top row detecting low-energy photons and the bottom layer detecting high-energy photons, this method may provide high detection efficiencies within the human diagnostic energy range (30-120keV) for breast cancer detection. According to a comparion of chest CT using DECT and SECT revealed that the mean CTDI vol is 7.6 ± 0.9 mGy vs. 9.9 ± 1.4 mGy (for patients with BMI ≤ 25 kg/m 2 ); 7.7 ± 0.9 mGy vs. 10.8 ± 1.6 mGy (for patients with BMI >25 to <30 kg/m 2 ); 9.3 ± 1.6 mGy vs. 13.3 ± 3.7 mGy (for patients with BMI ≥ 30 kg/m 2 ).…”

“…However, these approaches may require patients to be prospectively selected for DECT. In the latest generation, multiple energy spectral photon counting DECT systems use a dual-layer detector [22,23] to capture the characteristic attenuation of different materials at multiple energy spectrums, with the top row detecting low-energy photons and the bottom layer detecting high-energy photons, this method may provide high detection efficiencies within the human diagnostic energy range (30-120 keV) for breast cancer detection.…”