학술논문
Improved visualization of the bone-implant interface and osseointegration in ex vivo acetabular cup implants using photon-counting detector CT
Original Article
Original Article
Document Type
Academic Journal
Source
European Radiology Experimental. December 2023, Vol. 7 Issue 1
Subject
Language
English
Abstract
Author(s): Mischa Woisetschläger [sup.1] [sup.2], Ronald Booij [sup.2] [sup.3], Erik Tesselaar [sup.2] [sup.4], Edwin H. G. Oei [sup.3], Jörg Schilcher [sup.2] [sup.5] [sup.6] Author Affiliations: (1) grid.5640.7, 0000 0001 2162 [...]
Background Successful osseointegration of joint replacement implants is required for long-term implant survival. Accurate assessment of osseointegration could enable clinical discrimination of failed implants from other sources of pain avoiding unnecessary surgeries. Photon-counting detector computed tomography (PCD-CT) provides improvements in image resolution compared to conventional energy-integrating detector CT (EID-CT), possibly allowing better visualization of bone-implant-interfaces and osseointegration. The aim of this study was to assess the quality of visualization of bone-implant-interfaces and osseointegration in acetabular cup implants, using PCD-CT compared with EID-CT. Methods Two acetabular implants (one cemented, one uncemented) retrieved during revision surgery were scanned using PCD-CT and EID-CT at equal radiation dose. Images were reconstructed using different reconstruction kernels and iterative strengths. Delineation of the bone-implant and bone-cement-interface as an indicator of osseointegration was scored subjectively for image quality by four radiologists on a Likert scale and assessed quantitatively. Results Delineation of bone-implant and bone-cement-interfaces was better with PCD-CT compared with EID-CT (p [less than or equal to] 0.030). The highest ratings were given for PCD-CT at sharper kernels for the cemented cup (PCD-CT, median 5, interquartile range 4.25-5.00 versus EID-CT, 3, 2.00-3.75, p < 0.001) and the uncemented cup (5, 4.00-5.00 versus 2, 2-2, respectively, p < 0.001). The bone-implant-interface was 35-42% sharper and the bone-cement-interface was 28-43% sharper with PCD-CT compared with EID-CT, depending on the reconstruction kernel. Conclusions PCD-CT might enable a more accurate assessment of osseointegration of orthopedic joint replacement implants. Key points * The bone-implant interface ex vivo showed superior visualization using photon-counting detector computed tomography (PCD-CT) compared to energy-integrating detector computed tomography. * Harder reconstruction kernels in PCD-CT provide sharper images with lower noise levels. * These improvements in imaging might make it possible to visualize osseointegration in vivo.
Background Successful osseointegration of joint replacement implants is required for long-term implant survival. Accurate assessment of osseointegration could enable clinical discrimination of failed implants from other sources of pain avoiding unnecessary surgeries. Photon-counting detector computed tomography (PCD-CT) provides improvements in image resolution compared to conventional energy-integrating detector CT (EID-CT), possibly allowing better visualization of bone-implant-interfaces and osseointegration. The aim of this study was to assess the quality of visualization of bone-implant-interfaces and osseointegration in acetabular cup implants, using PCD-CT compared with EID-CT. Methods Two acetabular implants (one cemented, one uncemented) retrieved during revision surgery were scanned using PCD-CT and EID-CT at equal radiation dose. Images were reconstructed using different reconstruction kernels and iterative strengths. Delineation of the bone-implant and bone-cement-interface as an indicator of osseointegration was scored subjectively for image quality by four radiologists on a Likert scale and assessed quantitatively. Results Delineation of bone-implant and bone-cement-interfaces was better with PCD-CT compared with EID-CT (p [less than or equal to] 0.030). The highest ratings were given for PCD-CT at sharper kernels for the cemented cup (PCD-CT, median 5, interquartile range 4.25-5.00 versus EID-CT, 3, 2.00-3.75, p < 0.001) and the uncemented cup (5, 4.00-5.00 versus 2, 2-2, respectively, p < 0.001). The bone-implant-interface was 35-42% sharper and the bone-cement-interface was 28-43% sharper with PCD-CT compared with EID-CT, depending on the reconstruction kernel. Conclusions PCD-CT might enable a more accurate assessment of osseointegration of orthopedic joint replacement implants. Key points * The bone-implant interface ex vivo showed superior visualization using photon-counting detector computed tomography (PCD-CT) compared to energy-integrating detector computed tomography. * Harder reconstruction kernels in PCD-CT provide sharper images with lower noise levels. * These improvements in imaging might make it possible to visualize osseointegration in vivo.