Comparison of CT, MRI, and radiographs in assessing pelvic osteolysis: a cadaveric study.

In this study, we compared the accuracy of radiography, computed tomography, and magnetic resonance imaging in assessing periacetabular osteolytic lesions. Using a previously published cadaver model, we created 87 lesions in pelves implanted with total hip replacement components. The sensitivity for detecting lesions was 51.7% for radiography, 74.7% for computed tomography, and 95.4% for magnetic resonance imaging. For all three techniques, sensitivity increased as lesion size increased. Magnetic resonance imaging emerged as the most effective tool for detecting small periacetabular osteolytic lesions (< or = 3 cm). For lesions larger than 3 cm, which are of more concern clinically, computed tomography and magnetic resonance imaging were effective in identifying lesions with detection rates greater than 80%. For radiography and computed tomography, lesion detection was dependent on lesion location, whereas magnetic resonance imaging had consistently good sensitivity in all lesion locations. Although the mean volumetric errors for computed tomography and magnetic resonance imaging (0.3 cm and 0.8 cm) were small compared with mean lesion volume (6.1 cm), computed tomography was more accurate than magnetic resonance imaging at measuring lesion volume, with a lower mean absolute error. This study verifies the problems associated with radiographic detection of osteolysis while showing the effectiveness of computed tomography and magnetic resonance imaging in determining the presence of lesions and assessing their three-dimensional volume.