Novel PET/MR Imaging Approach for Persistent Postsurgical Pain Following Joint Replacement

Project Abstract
Overview: This project aims to develop a reliable 18F-fluorodeoxyglucose (18F-FDG) PET/MRI method with
novel metal artifact correction techniques to provide early identification of prosthetic complications causing
persistent postsurgical pain (PPSP) following total hip arthroplasty (THA).
Relevance: THA is one of the most rapidly growing procedures to treat the end-stage hip joint pain and
dysfunction, and its annual cases are estimated to reach 572,000 by 2030. Unfortunately, a substantial number
of patients experience PPSP after the procedure, which, without proper treatment, can significantly impair the
quality of life. However, the early identification of pain generators for these patients is very difficult because the
current diagnostic methods including X-ray, CT, and MRI, have limited sensitivity to pain and suffer from severe
artifacts induced by metal in prostheses. Therefore, there is a pressing need for a novel diagnostic approach to
accurately identify the abnormal inflammatory changes causing persistent pain to guide the appropriate
treatment matched to the exact sources of pain.
Approach: We propose the use of 18F-FDG PET/MRI for early identification of sources of PPSP following THA.
Our previous 18F-FDG PET/MRI study of chronic pain syndromes demonstrated promising improvements in
detecting sites of painful inflammation. However, the severe metal artifacts near metallic prostheses limit the
application of 18F-FDG PET/MRI to THA patients. Therefore, our first aim in this project is the development of
metal-aware attenuation correction for PET to enable reliable 18F-FDG PET near the metallic prosthesis. Our
second aim is the development of high-resolution hip MRI at 3T with metal artifact correction to improve our
ability for identifying structural causes of PPSP symptoms. Our third aim is to validate the improvements by 18F-
FDG PET/MRI in detection of the pain generators compared to PET/CT and conventional MRI. This will be
accomplished by correlating the pain score measurements with 18F-FDG PET/MRI abnormalities at 6 months,
12 months, and 18 months following the unilateral THA procedure.
Summary: We propose to develop a novel 18F-FDG PET/MRI approach with metal artifact correction methods
for early detection of periprosthetic complications causing PPSP following THA. Successful implementation of
our method will enable early indication of individualized, effective treatments for THA patients with PPSP.

Grant Number: 5R01AR077706-05
NIH Institute/Center: NIH
Principal Investigator: SANDIP BISWAL