Clinical utility of accelerated MAVRIC-SL with robust-PCA compared to conventional MAVRIC-SL in evaluation of total hip arthroplasties

OBJECTIVE. To compare the diagnostic performance of a conventional metal artifact suppression sequence MAVRIC-SL (multi-acquisition variable-resonance image combination selective) and a novel 2.6-fold faster sequence employing robust principal component analysis (RPCA), in the MR evaluation of hip implants at 3T. MATERIALS AND METHODS. 36 total hip implants in 25 patients were scanned at 3T using a conventional MAVRIC-SL proton density-weighted sequence and an RPCA MAVRIC-SL proton density-weighted sequence. Comparison was made of image quality, geometric distortion, visualization around acetabular and femoral components, and conspicuity of abnormal imaging findings using the Wilcoxon signed-rank test and a non-inferiority test. Abnormal findings were correlated with subsequent clinical management and intraoperative findings if the patient underwent subsequent surgery. RESULTS. Mean scores for conventional MAVRIC-SL were better than RPCA MAVRIC-SL for all qualitative parameters (p < 0.05), although the probability of RPCA MAVRIC-SL being clinically useful was non-inferior to conventional MAVRIC-SL (within our accepted 10% difference, p < 0.05), except for visualization around the acetabular component. Abnormal imaging findings were seen in 25 hips, and either equally visible or visible but less conspicuous on RPCA MAVRIC-SL in 21 out of 25 cases. In 4 cases a small joint effusion was queried on MAVRIC-SL but not RPCA MAVRIC-SL, but the presence or absence of a small effusion did not affect subsequent clinical management and patient outcome. CONCLUSION. While overall image quality is reduced, RPCA MAVRIC-SL allows for significantly reduced scan time and maintains almost equal diagnostic performance.