European Radiology

, Volume 28, Issue 5, pp 2216–2227 | Cite as

Metal artifact reduction MRI of total ankle arthroplasty implants

  • Cesar de Cesar Netto
  • Lucas F. Fonseca
  • Benjamin Fritz
  • Steven E. Stern
  • Esther Raithel
  • Mathias Nittka
  • Lew C. Schon
  • Jan Fritz



To assess high-bandwidth and compressed sensing-(CS)-SEMAC turbo spin echo (TSE) techniques for metal artifact reduction MRI of total ankle arthroplasty (TAA) implants.


Following institutional approval and consent, 40 subjects with TAA implants underwent 1.5-T MRI prospectively. Evaluations included bone-implant interfaces, anatomical structures, abnormal findings and differential diagnoses before and after MRI. AUCs of P-P plots were used to determine superiority. Statistical differences were evaluated with McNemar and chi-square tests. P-values ≤ 0.05 were considered significant.


CS-SEMAC TSE was superior to high-bandwidth TSE in showing the bone-implant interfaces (AUC=0.917), periprosthetic bone, tendons and joint capsule (AUC=0.337–0.766), bone marrow oedema (43 % difference, p=0.041), interface osteolysis (63 %, p=0.015), tendinopathy (62 %, p=0.062), periprosthetic fractures (60 %, p=0.250), synovitis (43 %, p=0.250), as well as reader confidence for bone marrow oedema (p=<0.001), fracture (p=0.001), interface osteolysis (p=0.003), synovitis (p=0.027) and tendinopathy (p=0.034). The number of differential diagnoses in symptomatic subjects after the MRI with CS-SEMAC decreased from 3 (1–4) to 1 (1–2) (p<0.001).


MRI of TAA implants with CS-SEMAC improves the diagnosis of interface osteolysis, periprosthetic bone marrow oedema, fractures and tendinopathy when compared to high-BW TSE, and has a positive effect on patient management.

Key Points

High-bandwidth TSE and compressed sensing SEMAC improve MRI of ankle arthroplasty implants.

Compressed sensing SEMAC improves bone-implant interfaces, periprosthetic bone, tendons and joint capsule visibility.

Compressed sensing SEMAC improves the diagnosis of osteolysis, tendinopathy, fractures and synovitis.

MRI decreases the number of clinical differential diagnoses of painful ankle arthroplasty implants.


Magnetic resonance imaging Ankle Arthroplasty Artifacts Joint prosthesis 

Abbreviations and acronyms


Area under the curve


Receiver bandwidth


Confidence interval


Compressed sensing


Intraclass correlation coefficient




Liquid crystal display


Multiacquisition Variable-Resonance Image Combination


Magnetic resonance imaging




Slice Encoding for Metal Artifact Correction


Short tau inversion recovery




Total ankle arthroplasty


Turbo spin echo



The authors would like to thank Christoph Forman, Jens Wetzl and Michael Zenge for their work on the image reconstruction framework.


This study has received funding by Siemens AG.

Compliance with ethical standards


The scientific guarantor of this publication is Jan Fritz.

Conflict of interest

The authors of this manuscript declare relationships with the following companies: Siemens AG.

Statistics and biometry

One of the authors has significant statistical expertise.

Ethical approval

Institutional Review Board approval was obtained.

Informed consent

Written informed consent was obtained from all subjects in this study.




performed at one institution

Supplementary material

330_2017_5153_MOESM1_ESM.tif (7.4 mb)
ESM 1 Bone-implant interface zones. The tibial and talar implant surfaces facing the host bone were divided into lateral, central and medial thirds, as well as five sectors in anterior to posterior direction, equating to a total of 15 tibial and 15 talar bone-implant interface zones. (tif 7.37 MB)
330_2017_5153_MOESM2_ESM.tif (2 mb)
ESM 2 P-P Plots for Compressed sensing (CS) slice Encoding for Metal Artifact Correction (SEMAC) versus high bandwidth (BW) turbo spin echo (TSE) magnetic resonance imaging (MRI) evaluations summarizing the overall results of the technical, implant and anatomical analyses. In the technical analysis, CS-SEMAC TSE images were superior in 35% of the readings, while high-BW TSE images were superior in 34% with an overall minimal preference for CS-SEMAC TSE images (Area under the curve (AUC) = 0.062). In the implant analysis, CS-SEMAC TSE images were superior in 97% of the readings, while high-BW images were superior in only 1% (AUC = 0.917). In the anatomical analysis, CS-SEMAC TSE images were superior in 42% of the readings, while high-BW was superior in 24% with a minimal preference for CS-SEMAC TSE images (AUC = 0.153). (tif 2.00 MB)


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Copyright information

© European Society of Radiology 2017

Authors and Affiliations

  1. 1.Department of Orthopedic SurgeryMedStar Union Memorial HospitalBaltimoreUSA
  2. 2.Russell H. Morgan Department of Radiology and Radiological ScienceJohns Hopkins University School of MedicineBaltimoreUSA
  3. 3.Department of RadiologyBalgrist University HospitalZurichSwitzerland
  4. 4.Faculty of MedicineUniversity of ZurichZurichSwitzerland
  5. 5.Bond Business SchoolBond UniversityGold CoastAustralia
  6. 6.Siemens Healthcare GmbHErlangenGermany

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