Improved visualization of the bone-implant interface and osseointegration in ex vivo acetabular cup implants using photon-counting detector CT

Mischa Woisetschläger; Ronald Booij; Erik Tesselaar; Edwin H.G. Oei; Jörg Schilcher

doi:10.1186/s41747-023-00335-y

Improved visualization of the bone-implant interface and osseointegration in ex vivo acetabular cup implants using photon-counting detector CT

Mischa Woisetschläger^*, Ronald Booij, Erik Tesselaar, Edwin H.G. Oei, Jörg Schilcher

^*Corresponding author for this work

Radiology & Nuclear Medicine

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Abstract

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 ≤ 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.

Original language	English
Article number	19
Journal	European radiology experimental
Volume	7
Issue number	1
DOIs	https://doi.org/10.1186/s41747-023-00335-y
Publication status	Published - 1 May 2023

Bibliographical note

Funding
Open access funding provided by Linköping University. The work for this study by RB was partly supported by the Van Leersum grant of the Academy Medical Sciences Fund, Royal Netherlands Academy of Arts & Sciences. This study was supported by ALF-grants from Region Östergötland, Sweden. We thank the Knut and Alice Wallenberg Foundation for generous support.

Publisher Copyright: © 2023. The Author(s).

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@article{125d7e9d70e84cac97fbee952f275306,

title = "Improved visualization of the bone-implant interface and osseointegration in ex vivo acetabular cup implants using photon-counting detector CT",

abstract = "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 ≤ 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.",

author = "Mischa Woisetschl{\"a}ger and Ronald Booij and Erik Tesselaar and Oei, {Edwin H.G.} and J{\"o}rg Schilcher",

note = "Funding Open access funding provided by Link{\"o}ping University. The work for this study by RB was partly supported by the Van Leersum grant of the Academy Medical Sciences Fund, Royal Netherlands Academy of Arts & Sciences. This study was supported by ALF-grants from Region {\"O}sterg{\"o}tland, Sweden. We thank the Knut and Alice Wallenberg Foundation for generous support. Publisher Copyright: {\textcopyright} 2023. The Author(s).",

year = "2023",

month = may,

day = "1",

doi = "10.1186/s41747-023-00335-y",

language = "English",

volume = "7",

journal = "European radiology experimental",

issn = "2509-9280",

publisher = "Springer Open",

number = "1",

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TY - JOUR

T1 - Improved visualization of the bone-implant interface and osseointegration in ex vivo acetabular cup implants using photon-counting detector CT

AU - Woisetschläger, Mischa

AU - Booij, Ronald

AU - Tesselaar, Erik

AU - Oei, Edwin H.G.

AU - Schilcher, Jörg

N1 - Funding Open access funding provided by Linköping University. The work for this study by RB was partly supported by the Van Leersum grant of the Academy Medical Sciences Fund, Royal Netherlands Academy of Arts & Sciences. This study was supported by ALF-grants from Region Östergötland, Sweden. We thank the Knut and Alice Wallenberg Foundation for generous support. Publisher Copyright: © 2023. The Author(s).

PY - 2023/5/1

Y1 - 2023/5/1

N2 - 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 ≤ 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.

AB - 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 ≤ 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.

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U2 - 10.1186/s41747-023-00335-y

DO - 10.1186/s41747-023-00335-y

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JO - European radiology experimental

JF - European radiology experimental

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ER -

Improved visualization of the bone-implant interface and osseointegration in ex vivo acetabular cup implants using photon-counting detector CT

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