Zimel Melissa N, Hwang Sinchun, Riedel Elyn R, Healey John H
Orthopaedic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave., New York, NY, 10065, USA.
Skeletal Radiol. 2015 Sep;44(9):1317-25. doi: 10.1007/s00256-015-2158-9. Epub 2015 May 17.
This study assessed whether radiolucent carbon fiber reinforced-polyetheretherketone (CFR-PEEK) intramedullary nails decreased hardware artifact on magnetic resonance imaging (MRI) and computed tomography (CT) in vitro and in an oncologic patient population.
In vitro and clinical evaluations were done. A qualitative assessment of metal artifact was performed using CFR-PEEK and titanium nail MRI phantoms. Eight patients with a femoral or tibial prophylactic CFR-PEEK nail were retrospectively identified. All patients had postoperative surveillance imaging by MRI, CT, and were followed for a median 20 months (range, 12-28 months). CFR-PEEK images were compared to images from a comparative group of patients with titanium femoral intramedullary nails who had a postoperative MRI or CT. A musculoskeletal-trained radiologist graded visualization of the cortex, corticomedullary junction, and bone-muscle interface, on T1-weighted (T1W), STIR, and contrast-enhanced T1-weighted fat-saturated (T1W FS) sequences of both groups with a five-point scale, performing independent reviews 4 months apart. Statistical analysis used the Wilcoxon rank-sum test and a weighted kappa.
Substantially less MRI signal loss occurred in the CFR-PEEK phantom than in the titanium phantom simulation, particularly as the angle increased with respect to direction of the static magnetic field. CFR-PEEK nails had less MRI artifact than titanium nails on scored T1W, STIR, and contrast-enhanced T1W FS MRI sequences (p ≤ 0.03). The mean weighted kappa was 0.64, showing excellent intraobserver reliability between readings.
CFR-PEEK intramedullary nail fixation is a superior alternative to minimize implant artifact on MRI or CT imaging for patients requiring long bone fixation.
本研究评估了射线可透过的碳纤维增强聚醚醚酮（CFR-PEEK）髓内钉在体外以及在肿瘤患者群体中是否能减少磁共振成像（MRI）和计算机断层扫描（CT）上的金属伪影。
进行了体外和临床评估。使用CFR-PEEK和钛钉MRI体模对金属伪影进行了定性评估。回顾性确定了8例使用股骨或胫骨预防性CFR-PEEK钉的患者。所有患者术后均接受了MRI、CT监测成像，并随访了中位时间20个月（范围12 - 28个月）。将CFR-PEEK图像与一组使用钛制股骨髓内钉且术后接受MRI或CT检查的对照患者的图像进行比较。一位经过肌肉骨骼培训的放射科医生在两组的T1加权（T1W）、短TI反转恢复（STIR）和对比增强T1加权脂肪抑制（T1W FS）序列上，采用五点量表对皮质、皮质髓质交界和骨-肌肉界面的可视化程度进行分级，间隔4个月进行独立评估。统计分析采用Wilcoxon秩和检验和加权kappa值。
CFR-PEEK体模中的MRI信号损失明显少于钛体模模拟，特别是当角度相对于静磁场方向增加时。在评分的T1W、STIR和对比增强T1W FS MRI序列上，CFR-PEEK钉的MRI伪影少于钛钉（p≤0.03）。平均加权kappa值为0.64，显示出两次读数之间观察者内部的可靠性极佳。
对于需要长骨固定的患者，CFR-PEEK髓内钉固定是减少MRI或CT成像上植入物伪影的更佳选择。
