ABSTRACT
Background@#Plain computed tomography (CT) and magnetic resonance imaging (MRI) are useful for diagnosing adverse local tissue reactions after metal-on-metal total hip arthroplasty (THA), but metal artifacts can hamper radiological assessments near the implants. We sought to clarify the usefulness of 18F-fluorodeoxyglucose positron-emission tomography (18F-FDG-PET) CT and MRI in the periprosthetic region, which is difficult to assess after THA due to metal artifacts. @*Methods@#We performed preoperative 18F-FDG-PET/CT and 18F-FDG-PET/MRI, as well as plain CT and MRI, in 11 metal-on-metal THA patients who underwent revision surgery. @*Results@#Most patients showed high FDG uptake in the metal artifact areas and pseudotumors in the 18-F-FDG-PET/CT and 18-FFDG-PET/MRI scans. Intraoperative intra-articular macroscopic and histopathological intra-articular granulation tissue findings were suggestive of adverse local tissue reaction. @*Conclusions@#The enhanced uptake in the metal artifact areas seemed to reflect adverse local tissue reaction. Therefore, 18F-FDGPET/CT and 18-F-FDG-PET/MRI can be useful for the auxiliary diagnosis of adverse local tissue reactions after metal-on-metal THA.
ABSTRACT
Background@#Plain computed tomography (CT) and magnetic resonance imaging (MRI) are useful for diagnosing adverse local tissue reactions after metal-on-metal total hip arthroplasty (THA), but metal artifacts can hamper radiological assessments near the implants. We sought to clarify the usefulness of 18F-fluorodeoxyglucose positron-emission tomography (18F-FDG-PET) CT and MRI in the periprosthetic region, which is difficult to assess after THA due to metal artifacts. @*Methods@#We performed preoperative 18F-FDG-PET/CT and 18F-FDG-PET/MRI, as well as plain CT and MRI, in 11 metal-on-metal THA patients who underwent revision surgery. @*Results@#Most patients showed high FDG uptake in the metal artifact areas and pseudotumors in the 18-F-FDG-PET/CT and 18-FFDG-PET/MRI scans. Intraoperative intra-articular macroscopic and histopathological intra-articular granulation tissue findings were suggestive of adverse local tissue reaction. @*Conclusions@#The enhanced uptake in the metal artifact areas seemed to reflect adverse local tissue reaction. Therefore, 18F-FDGPET/CT and 18-F-FDG-PET/MRI can be useful for the auxiliary diagnosis of adverse local tissue reactions after metal-on-metal THA.
ABSTRACT
Disorders involving artificial joints are difficult to evaluate due to metal artifacts hindering plain computed tomography (CT) or magnetic resonance imaging (MRI). In the current case study 18F-fluoro-deoxyglucose positron emission tomography (18F-FDG-PET)/CT and MRI were used to confirm iliopsoas tendonitis within the metal artifact area following total hip arthroplasty (THA). The patient was a 61-year-old woman who developed hip pain on flexion of the ipsilateral hip after THA. Imaging studies were performed to evaluate for iliopsoas tendonitis due to impingement with the cup. Assessment of the iliopsoas muscle near the artificial joint was difficult due to the metal artifact on plain CT and MRI. Imaging using 18F-FDG-PET/CT and 18F-FDGPET/MRI showed uptake along the iliopsoas muscle. Therefore, revision was performed to resolve iliopsoas tendon impingement, and the preoperative pain resolved. The result of the current case study suggest 18F-FDGPET/CT or 18F-FDG-PET/MRI will be useful to detect iliopsoas tendonitis within metal artifact areas after THA.
ABSTRACT
Disorders involving artificial joints are difficult to evaluate due to metal artifacts hindering plain computed tomography (CT) or magnetic resonance imaging (MRI). In the current case study 18F-fluoro-deoxyglucose positron emission tomography (18F-FDG-PET)/CT and MRI were used to confirm iliopsoas tendonitis within the metal artifact area following total hip arthroplasty (THA). The patient was a 61-year-old woman who developed hip pain on flexion of the ipsilateral hip after THA. Imaging studies were performed to evaluate for iliopsoas tendonitis due to impingement with the cup. Assessment of the iliopsoas muscle near the artificial joint was difficult due to the metal artifact on plain CT and MRI. Imaging using 18F-FDG-PET/CT and 18F-FDGPET/MRI showed uptake along the iliopsoas muscle. Therefore, revision was performed to resolve iliopsoas tendon impingement, and the preoperative pain resolved. The result of the current case study suggest 18F-FDGPET/CT or 18F-FDG-PET/MRI will be useful to detect iliopsoas tendonitis within metal artifact areas after THA.
ABSTRACT
Sixteen consecutively seen patients underwent surgical repair for complications following acute myocardial infarction. There were two cases with acute mitral regurgitation due to posterior papillary muscle rupture, who underwent mitral valve replacement with a prosthetic valve. There were three cases of postinfarction left ventricular free wall rupture. In all cases, horizontal mattress suture with Teflon felt strip was used in order to close the myocardial tear. The two out of three who survived had been placed on percutaneous cardiopulmonary support prior to the operation. There were 11 cases of postinfarction ventricular septal perforation. The surgical procedures consisted of simple patch closure (Daggett's method) in 7 cases, direct closure in one case, apical amputation in one case and endocardial patch repair with infarct exclusion (Komeda-David method) in the most recent two cases. Six out of eleven survived. Early diagnosis and surgical treatment are mandatory to save these patients. Intraaortic balloon pumping and percutaneous cardiopulmonary support prior to the operation have been used to advantage in some patients.
ABSTRACT
Three surgical cases of postinfarction left ventricular free wall rupture (LVFWR) are described. Patient 1, a 76-year-old woman, developed LVFWR of the posterior wall after acute myocardial infarction (AMI). Coronary arteriography (CAG) revealed total occlusion of left circumflex artery (Cx) (#11). Direct closure of the myocardial tear was performed using cardiopulmonary bypass (CPB) and cardiac arrest. Patient 2, a 67-year-old man, developed LVFWR of the anterior wall after AMI. CAG revealed total occlusion of left anterior descending artery (LAD) (#7). He was placed on a percutaneous cardiopulmonary support system (POPS) prior to the operation and direct closure of the myocardial tear was performed with the heart beating. Patient 3, a 57-year-old man, developed LVFWR of the posterior wall after AMI. CAG revealed total occlusion of Cx (#13). He was placed on PCPS prior to the operation and direct closure of the myocardial tear was performed using CPB and cardiac arrest. Patients 2 and 3 who were placed on PCPS prior to the operation successfully underwent emergency operations. In all cases, 2-0 Prolene horizontal mattress sutures with Teflon felt strips were used through the infarcted area in order to close the myocardial tear.