Diffusion-weighted MRI of total hip arthroplasty for classification of synovial reactions: A pilot study

Conventional quantitative diffusion-weighted imaging (DWI) is sensitive to changes in tissue microstructure, but its application to evaluating patients with orthopaedic hardware has generally been limited due to metallic susceptibility artifacts. The apparent diffusion coefficient (ADC) and T₂-values from a multi-spectral imaging (MSI) DWI combined with 2D multi-spectral imaging with a 2D periodically rotated overlapping parallel lines with enhanced reconstruction (2D-MSI PROPELLER DWI) based sequence and a MAVRIC based T₂ mapping sequence, respectively, may mitigate the artifact and provide additional quantitative information on synovial reactions in individuals with total hip arthroplasty (THA). The aim of this pilot study is to utilize a 2D-MSI PROPELLER DWI and a MAVRIC-based T₂ mapping to evaluate ADC and T₂-values of synovial reactions in patients with THA.

Coronal morphologic MRIs from THA patients underwent evaluation of the synovium and were assigned a synovial classification of 'normal', or 'grouped abnormal' (consisting of sub-groups 'infection', 'polymeric', 'metallosis', 'adverse local tissue reaction' [ALTR], or 'non-specific') and type of synovial reaction present (fluid-like, solid-like, or mixed). Regions of interest (ROIs) were placed in synovial reactions for measurement of ADC and T₂-values, obtained from the 2D-MSI PROPELLER DWI and T₂-MAVRIC sequences, respectively. A one-way analysis of variance (ANOVA) and Kruskal-Wallis rank sum tests were used to compare the differences in ADC and T₂-values across the different synovial reaction classifications. A Kruskal-Wallis test was used to compare the ROI areas for the ADC and T₂-values. A principal component analysis (PCA) was performed to evaluate the possible effects of ADC values, size of the ADC ROI, T₂-values, and size of the T₂ ROI with respect to synovial reaction classification.

Differences of ADC and T₂ among the individual synovial reactions were not found. A difference of ADC between 'normal' and 'grouped abnormal' synovial reactions was also not detected even as the ADC area of 'grouped abnormal' synovial reactions were significantly larger (p = 0.02). The 'grouped abnormal' synovial reactions had significantly shorter T₂-values than 'normal' synovial reactions (p = 0.02), and that the T₂ area of 'grouped abnormal' synovial reactions were significantly larger (p = 0.01). A larger ROI area on the T₂-maps was observed in the mixed synovial reaction type as compared to the fluid-like reaction type area (p = 0.01). Heterogeneity was noted in calculated ADC and T₂ maps. PCA analysis revealed obvious clustering by the 'normal' and 'grouped abnormal' classifications.

2D-MSI PROPELLER DWI and MAVRIC-T₂ generate quantitative images of periprosthetic tissues within clinically feasible scan times. The combination of derived ADC and T₂-values with area of synovial reaction may aid in differentiating normal from abnormal synovial reactions between types of synovial reactions in patients with THA.