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Case Reports
. 2016 May 6;18(1):29.
doi: 10.1186/s12968-016-0248-z.

Detection of metallic cobalt and chromium liver deposition following failed hip replacement using T2* and R2 magnetic resonance

Amna Abdel-Gadir  1   2 , Reshid Berber  3 , John B Porter  4 , Paul D Quinn  5 , Deepak Suri  6 , Peter Kellman  7 , Alister J Hart  3 , James C Moon  1   2 , Charlotte Manisty  8   9 , John A Skinner  3
Affiliations
Case Reports

Detection of metallic cobalt and chromium liver deposition following failed hip replacement using T2* and R2 magnetic resonance

Amna Abdel-Gadir et al. J Cardiovasc Magn Reson. .

Abstract

Background: Failed hip prostheses can cause elevated circulating cobalt and chromium levels, with rare reports of fatal systemic organ deposition, including cobalt cardiomyopathy. Although blood cobalt and chromium levels are easily measured, organ deposition is difficult to detect without invasive biopsy. The T2* magnetic resonance (MR) method is used to quantify tissue iron deposition, and plays an important role in the management of iron-loading conditions. Cobalt and chromium, like iron, also affect magnetism and are proposed MR contrast agents.

Case presentation: We describe a case of a 44-year-old male with a failed hip implant and very elevated blood cobalt and chromium levels. Despite normal cardiac MR findings, liver T2* and R2 values were abnormal, triggering tissue biopsy. Liver tissue analysis, including X-ray fluorescence, demonstrated heavy elemental cobalt and chromium deposition in macrophages, and no detectable iron.

Conclusions: Our case demonstrates T2* and R2 quantification of liver metal deposition in a patient with a failed hip implant. Further work is needed to investigate the role of T2* and R2 MR in the detection of metal deposition from metal on metal hip prostheses.

Keywords: Chromium; Cobalt; MRI; Metal loading; Metal-on-metal hip; T2*.

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Figures

Fig. 1
Fig. 1
Liver T2* MR maps of patient compared with healthy volunteer. Left panel (a) shows the patient with a low T2* (final scan), compared to a healthy volunteer shown in the right panel (b) with normal T2* values
Fig. 2
Fig. 2
Analysis of liver biopsy tissue using micro X-ray Fluorescence (μXRF, left) found cobalt and chromium co-localised in macrophages (right). Left: μXRF element distribution color maps with 4 μm resolution - Co (green), Cr (red) and Calcium, Ca (blue) showing deposits (white arrow). The Ca distribution provides a background image of the tissue. Right: the same slide subsequently H&E stained showing aggregates of pigmented macrophages (black arrow)
See this image and copyright information in PMC

References

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