{"corpus_id":34634898,"paper_sha":"21b4490b520f8a170283e7c58a6bb5547daf72a6","doi":"10.1302/0301-620X.98B1.36746","arxiv_id":null,"pmid":26733514,"pmcid":"4714034","mag_id":2418163653,"dblp_id":null,"acl_id":null,"title":"Which imaging modality is most effective for identifying pseudotumours in metal-on-metal hip resurfacings requiring revision","year":2016,"publication_date":"2016-01-01","venue":"The Bone & Joint Journal","journal":{"name":"The Bone & Joint Journal","pages":"40 - 48","volume":"98-B"},"journal_issn":null,"journal_title":null,"publication_types":["JournalArticle","Study"],"pubmed_pub_types":["Comparative Study","Journal Article","Research Support, Non-U.S. Gov't"],"s2_fields_of_study":["Medicine","Engineering"],"reference_count":34,"citation_count":35,"influential_citation_count":3,"is_open_access":false,"arxiv_categories":null,"arxiv_license":null,"arxiv_journal_ref":null,"mesh_headings":[{"d":"Adult","mj":false,"ui":"D000328"},{"d":"Aged","mj":false,"ui":"D000368"},{"d":"Arthroplasty, Replacement, Hip","mj":false,"qs":[{"q":"adverse effects","mj":true,"ui":"Q000009"}],"ui":"D019644"},{"d":"Female","mj":false,"ui":"D005260"},{"d":"Granuloma, Plasma Cell","mj":false,"qs":[{"q":"diagnosis","mj":true,"ui":"Q000175"},{"q":"diagnostic imaging","mj":false,"ui":"Q000000981"}],"ui":"D006104"},{"d":"Hemiarthroplasty","mj":false,"qs":[{"q":"adverse effects","mj":false,"ui":"Q000009"}],"ui":"D062785"},{"d":"Hip Prosthesis","mj":false,"ui":"D006622"},{"d":"Humans","mj":false,"ui":"D006801"},{"d":"Magnetic Resonance Imaging","mj":false,"ui":"D008279"},{"d":"Male","mj":false,"ui":"D008297"},{"d":"Metal-on-Metal Joint Prostheses","mj":false,"qs":[{"q":"adverse effects","mj":true,"ui":"Q000009"}],"ui":"D061825"},{"d":"Middle Aged","mj":false,"ui":"D008875"},{"d":"Multimodal Imaging","mj":false,"qs":[{"q":"methods","mj":false,"ui":"Q000379"}],"ui":"D064847"},{"d":"Prospective Studies","mj":false,"ui":"D011446"},{"d":"Prosthesis Failure","mj":false,"qs":[{"q":"adverse effects","mj":false,"ui":"Q000009"}],"ui":"D011475"},{"d":"Reoperation","mj":false,"ui":"D012086"},{"d":"Retrospective Studies","mj":false,"ui":"D012189"},{"d":"Sensitivity and Specificity","mj":false,"ui":"D012680"},{"d":"Ultrasonography","mj":false,"ui":"D014463"}],"chemicals":null,"comments_corrections":null,"source_flags":5,"s2_open_access_pdf_url":null,"s2_open_access_landing_url":null,"s2_open_access_license":null,"s2_open_access_status":null,"pmc_open_access_pdf_url":null,"pmc_open_access_landing_url":null,"pmc_open_access_license":null,"pmc_open_access_status":null,"unpaywall_open_access_pdf_url":null,"unpaywall_open_access_landing_url":null,"unpaywall_open_access_license":null,"unpaywall_open_access_status":null,"abstract":"Aims The aims of this study were to compare the diagnostic test characteristics of ultrasound alone, metal artefact reduction sequence MRI (MARS-MRI) alone, and ultrasound combined with MARS-MRI for identifying intra-operative pseudotumours in metal-on-metal hip resurfacing (MoMHR) patients undergoing revision surgery. Methods This retrospective diagnostic accuracy study involved 39 patients (40 MoMHRs). The time between imaging modalities was a mean of 14.6 days (0 to 90), with imaging performed at a mean of 5.3 months (0.06 to 12) before revision. The prevalence of intra-operative pseudotumours was 82.5% (n = 33). Results Agreement with the intra-operative findings was 82.5% (n = 33) for ultrasound alone, 87.5% (n = 35) for MARS-MRI alone, and 92.5% (n = 37) for ultrasound and MARS-MRI combined. The diagnostic characteristics for ultrasound alone and MARS-MRI alone reached similar sensitivities (90.9% vs 93.9%) and positive predictive values (PPVs; 88.2% vs 91.2%), but higher specificities (57.1% vs 42.9%) and negative predictive values (NPVs; 66.7% vs 50.0%) were achieved with MARS-MRI. Ultrasound and MARS-MRI combined produced 100% sensitivity and 100% NPV, whilst maintaining both specificity (57.1%) and PPV (91.7%). For the identification of a pseudotumour, which was confirmed at revision surgery, agreement was substantial for ultrasound and MARS-MRI combined (κ = 0.69), moderate for MARS-MRI alone (κ = 0.54), and fair for ultrasound alone (κ = 0.36). Discussion These findings suggest that ultrasound and/or MARS-MRI have a role when assessing patients with a MoMHR, with the choice dependent on local financial constraints and the availability of ultrasound expertise. However in patients with a MoMHR who require revision, combined imaging was most effective. Take home message: Combined imaging with ultrasound and MARS-MRI always identified intra-operative pseudotumours if present. Furthermore, if neither imaging modality showed a pseudotumour, one was not found intra-operatively. 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intra-operative findings (92.5%, n = 37) than ultrasound alone (82.5%, n = 33) or MARS-MRI alone (87.5%, n = 35).","confidence":0.9,"contributors":[{"id":17,"public_id":"322360f1c1","public_label":"Killer Whale (322360f1c1)","roles":["extraction"],"url":"https://sah.borca.ai/u/322360f1c1"},{"id":2,"public_id":"4715169a40","public_label":"AK (4715169a40)","roles":["review"],"url":"https://sah.borca.ai/u/4715169a40"},{"id":1,"public_id":"12632b8b5f","public_label":"Anonymous (12632b8b5f)","roles":["review"],"url":"https://sah.borca.ai/u/12632b8b5f"}],"url":"https://sah.borca.ai/claims/cl_d18bf02d447242095760cb68240d3f3a"},{"public_id":"cl_922ff7df0ae6006c1aa9f8575ba9eaa5","status":"active","text":"Combined ultrasound and MARS-MRI produced 100% sensitivity and 100% negative predictive value for identifying intra-operative pseudotumours, while maintaining a specificity of 57.1% and a positive predictive value of 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