Predictability of magnetic susceptibility artifacts from metallic orthodontic appliances in magnetic resonance imaging

Comparison of T1-weighted landmark placement and ROI transfer onto diffusion-weighted EPI sequences for targeted tractography tasks in the optic nerve

Diffusion-based tractography in the optic nerve requires sampling strategies assisted by anatomical landmark information (regions of interest [ROIs]). We aimed to investigate the feasibility of expert-placed, high-resolution T1-weighted ROI-data transfer onto lower spatial resolution diffusion-weighted images. Slab volumes from 20 volunteers were acquired and preprocessed including distortion bias correction and artifact reduction. Constrained spherical deconvolution was used to generate a directional diffusion information grid (fibre orientation distribution-model [FOD]). Three neuroradiologists marked landmarks on both diffusion imaging variants and structural datasets. Structural ROI information (volumetric interpolated breath-hold sequence [VIBE]) was respectively registered (linear with 6/12 degrees of freedom [DOF]) onto single-shot EPI (ss-EPI) and readout-segmented EPI (rs-EPI) volumes, respectively. All eight ROI/FOD-combinations were compared in a targeted tractography task of the optic nerve pathway. Inter-rater reliability for placed ROIs among experts was highest in VIBE images (lower confidence interval 0.84 to 0.97, mean 0.91) and lower in both ss-EPI (0.61 to 0.95, mean 0.79) and rs-EPI (0.59 to 0.86, mean 0.70). Tractography success rate based on streamline selection performance was highest in VIBE-drawn ROIs registered (6-DOF) onto rs-EPI FOD (70.0% over 5%-threshold, capped to failed ratio 39/16) followed by both 12-DOF-registered (67.5%; 41/16) and nonregistered VIBE (67.5%; 40/23). On ss-EPI FOD, VIBE-ROI-datasets obtained fewer streamlines overall with each at 55.0% above 5%-threshold and with lower capped to failed ratio (6-DOF: 35/36; 12-DOF: 34/34, nonregistered 33/36). The combination of VIBE-placed ROIs (highest inter-rater reliability) with 6-DOF registration onto rs-EPI targets (best streamline selection performance) is most suitable for white matter template generation required in group studies.

In vivo assessment of artefacts in MRI images caused by conventional twistflex and various fixed orthodontic CAD/CAM retainers

PURPOSE

To assess magnetic resonance imaging (MRI) artefacts caused by different computer-aided design/computer-aided manufacturing (CAD/CAM) retainers in comparison with conventional hand bent stainless steel twistflex retainers in vivo.

MATERIALS AND METHODS

MRI scans (3 Tesla) were performed on a male volunteer with different CAD/CAM retainers (cobalt-chromium, CoCr; nickel-titanium, NiTi; grade 5 titanium, Ti5) and twistflex retainers inserted. A total of 126 landmarks inside and outside the retainer area (RA; from canine to canine) were evaluated by two blinded radiologists using an established five-point visibility scoring (1: excellent, 2: good, 3: moderate, 4: poor, 5: not visible). Friedman and two-tailed Wilcoxon tests were used for statistical analysis (significance level: p < 0.05).

RESULTS

Twistflex retainers had the strongest impact on the visibility of all landmarks inside (4.0 ± 1.5) and outside the RA (1.7 ± 1.2). In contrast, artefacts caused by CAD/CAM retainers were limited to the dental area inside the RA (CoCr: 2.2 ± 1.2) or did not impair MRI-based diagnostics in a clinically relevant way (NiTi: 1.0 ± 0.1; Ti5: 1.4 ± 0.6).

CONCLUSION

The present study on a single test person demonstrates that conventional stainless steel twistflex retainers can severely impair the diagnostic value in head/neck and dental MRI. By contrast, CoCr CAD/CAM retainers can cause artefacts which only slightly impair dental MRI but not head/neck MRI, whereas NiTi and Ti5 CAD/CAM might be fully compatible with both head/neck and dental MRI.

Diagnostic compatibility of various fixed orthodontic retainers for head/neck MRI and dental MRI

OBJECTIVES

To evaluate the diagnostic MRI compatibility of different fixed orthodontic retainers using a high-resolution 3D-sequence optimized for artifact reduction.

MATERIALS AND METHODS

Maxillary and mandibular retainers made of five different materials were scanned in vitro and in vivo at 3 T MRI using an MSVAT-SPACE sequence. In vitro, artifact volumes were determined for all maxillary and mandibular retainers (AVmax; AVmand). In vivo, two independent observers quantified the extent of artifacts based on the visibility of 124 dental and non-dental landmarks using a five-point rating scale (1 = excellent, 2 = good, 3 = acceptable, 4 = poor, 5 = not visible).

RESULTS

Rectangular-steel retainers caused the largest artifacts (AVmax/AVmand: 18,060/15,879 mm3) and considerable diagnostic impairment in vivo (mean landmark visibility score ± SD inside/outside the retainer areas: 4.8 ± 0.8/2.9 ± 1.6). Smaller, but diagnostically relevant artifacts were observed for twistflex steel retainers (437/6317 mm3, 3.1 ± 1.7/1.3 ± 0.7). All retainers made of precious-alloy materials produced only very small artifact volumes (titanium grade 1: 70/46 mm3, titanium grade 5: 47/35 mm3, gold: 23/21 mm3) without any impact on image quality in vivo (each retainer: visibility scores of 1.0 ± 0.0 for all landmarks inside and outside the retainer areas).

CONCLUSIONS

In contrast to steel retainers, titanium and gold retainers are fully compatible for both head/neck and dental MRI when using MSVAT-SPACE.

CLINICAL RELEVANCE

This study demonstrates that titanium and gold retainers do not impair the diagnostic quality of head/neck and dental MRI when applying an appropriate artifact-reduction technique. Steel retainers, however, are not suitable for dental MRI and can severely impair image quality in head/neck MRI of the oral cavity.

Magnetic resonance imaging artefacts caused by orthodontic appliances and/or implant-supported prosthesis: a systematic review

OBJECTIVES

Dental materials, including orthodontic appliances and implants, are commonly mentioned as a possible source of artefacts in magnetic resonance imaging (MRI). The aim of the present study was to undertake a systematic review of the relevant literature on MR image artefacts due to dental materials, limited to orthodontic appliances and implant-supported dental prosthesis, on both technical and diagnostic levels.

METHODS

The MEDLINE (PubMed) bibliographic database was searched up to September 2020. The search was limited to studies published in English, using the search string: (MRI or magnetic resonance) and (artefact or artifact) and (dental or ortho or implant or restoration or restorative). The studies were assessed independently by three reviewers, focusing on the following parameters: MRI sequences, tested materials, assessed parameters, efficacy level and outcome.

RESULTS

The search strategy yielded 31 studies, which were included in this systematic review. These studies showed that metallic dental materials, commonly present in orthodontic appliances and implant-supported dental prosthesis led to diverse types/severities of artefacts in MR images. Fifteen studies were in vivo, based on human subjects. The studies differed substantially in terms of tested materials, assessed parameters, and outcome measurements.

CONCLUSIONS

Metallic dental materials cause artefacts of diverse types and severities in MR images of the head and neck region. However, the diagnostic relevance of the investigated artefacts for the diverse MRI applications is yet to be studied.

Dental MRI-only a future vision or standard of care? A literature review on current indications and applications of MRI in dentistry

MRI is increasingly used as a diagnostic tool for visualising the dentoalveolar complex. A comprehensive review of the current indications and applications of MRI in the dental specialities of orthodontics (I), endodontics (II), prosthodontics (III), periodontics (IV), and oral surgery (V), pediatric dentistry (VI), operative dentistry is still missing and is therefore provided by the present work.The current literature on dental MRI shows that it is used for cephalometry in orthodontics and dentofacial orthopaedics, detection of dental pulp inflammation, characterisation of periapical and marginal periodontal pathologies of teeth, caries detection, and identification of the inferior alveolar nerve, impacted teeth and dentofacial anatomy for dental implant planning, respectively. Specific protocols regarding the miniature anatomy of the dentofacial complex, the presence of hard tissues, and foreign body restorations are used along with dedicated coils for the improved image quality of the facial skull.Dental MRI poses a clinically useful radiation-free imaging tool for visualising the dentoalveolar complex across dental specialities when respecting the indications and limitations.

The intraoral permeability measurement as a screening for artifact formation by orthodontic products in MRI

AIM

Metal dental products lack precautionary statements regarding MR compatibility due to an exemption in the labelling obligation. Hence, it is difficult for radiologists to decide whether to remove fixed metal objects in patients prior to MRI. A solution could be the direct determination of the magnetic permeability (µ_r) as a decisive material-related predictor of artifact formation and other interactions. Thus, the applicability of an industrially used measurement device as a screening instrument and the relevance of the manufacturer's application restrictions in vitro and in vivo were tested.

METHODS

Precision and trueness were tested using self-made test objects with different dimensions and different permeability. To clarify whether the measurement results are affected by the remanence (B_R) induced in the objects, 28 brackets of different materials were exposed to a weak and a strong external magnetic field and the magnetic flux density before and after these exposures was compared. The clinical test was performed on a volunteer with an orthodontic appliance experimentally composed of brackets with different levels of magnetic permeability (µ_r). Validity and intra- and interrater reliability were calculated using two rater groups consisting of four dentists and four medical-technical radiology assistants (MTRA), respectively.

RESULTS

With coefficients of variation below 0.14%, precision was excellent regardless of object surface and size. Trueness was high on objects with µ_r ≤ 1.002, and decreased with increasing µ_r, for which size-dependent correction factors were calculated. Intra- and interrater reliability and validity were excellent and independent of professional intraoral manipulation experience.

CONCLUSIONS

The permeability measurement allows for a valid and reliable determination of the magnetizability of intraoral metal objects. When used as a screening tool to detect nonartifact-causing objects, no correction factor needs to be calculated. For the first time, it offers radiologists a decision support for the selective removal of only the highly permeable components of the multiband apparatus.

Trabecular Bone Assessment Using Magnetic-Resonance Imaging: A Pilot Study

The aim of this study was to assess trabecular bone morphology via magnetic-resonance imaging (MRI) using microcomputed tomography (µCT) as the control group. Porcine bone samples were scanned with T1-weighted turbo spin echo sequence imaging, using TR 25 ms, TE 3.5 ms, FOV 100 × 100 × 90, voxel size 0.22 × 0.22 × 0.50 mm, and scan time of 11:18. µCT was used as the control group with 80 kV, 125 mA, and a voxel size of 16 µm. The trabecular bone was segmented on the basis of a reference threshold value and morphological parameters. Bone volume (BV), Bone-volume fraction (BvTv), Bone specific surface (BsBv), trabecular thickness (TbTh), and trabecular separation (TbSp) were evaluated. Paired t-test and Pearson correlation test were performed at p = 0.05. MRI overestimated BV, BvTv, TbTh, and TbSp values. BsBv was the only parameter that was underestimated by MRI. High statistical correlation (r = 0.826; p < 0.05) was found for BV measurements. Within the limitations of this study, MRI overestimated trabecular bone parameters, but with a statistically significant fixed linear offset.

Evaluation of magnetic resonance imaging artifacts caused by fixed orthodontic CAD/CAM retainers-an in vitro study

Objectives

Magnetic resonance imaging (MRI) image quality can be severely impaired by artifacts caused by fixed orthodontic retainers. In clinical practice, there is a trend towards using computer-aided design/computer-aided manufacturing (CAD/CAM) retainers. This study aimed to quantify MRI artifacts produced by these novel CAD/CAM retainers.

Material and methods

Three CAD/CAM retainers and a stainless-steel retainer (“Twistflex”; clinical reference standard) were scanned in vitro at 3-T MRI using a high-resolution 3D sequence. The artifact diameters and three-dimensional artifact volumes (AV) were determined for all mandibular (AV_mand) and maxillary (AV_max) retainers. Moreover, the corresponding ratio of artifact volume to retainer volume (AV/RV_mand, AV/RV_max) was calculated.

Results

Twistflex caused large artifact volumes (AV_mand: 13530 mm³; AV_max: 15642 mm³; AV/RV_mand: 2602; AV/RV_max: 2235). By contrast, artifact volumes for CAD/CAM retainers were substantially smaller: whereas artifact volumes for cobalt–chromium retainers were moderate (381 mm³; 394 mm³; 39; 31), grade-5 titanium (110 mm³; 126 mm³; 12; 12) and nickel–titanium (54 mm³; 78 mm³; 12; 14) both produced very small artifact volumes.

Conclusion

All CAD/CAM retainers caused substantially smaller volumes of MRI artifacts compared to Twistflex. Grade-5 titanium and nickel–titanium CAD/CAM retainers showed the smallest artifact volumes.

Clinical relevance

CAD/CAM retainers made from titanium or nickel–titanium may not relevantly impair image quality in head/neck and dental MRI. Artifacts caused by cobalt–chromium CAD/CAM retainers may mask nearby dental/periodontal structures. In contrast, the large artifacts caused by Twistflex are likely to severely impair diagnosis of oral and adjacent pathologies.

Magnetic resonance imaging artifacts produced by dental implants with different geometries

OBJECTIVES

The purpose of this study was to evaluate the MRI-artifact pattern produced by titanium and zirconia dental implants with different geometries (diameter and height).

METHODS

Three titanium (Titan SLA, Straumann) and three zirconia (Pure Ceramic Implant, Straumann) dental implants differing on their design (diameter x height) were installed in porcine bone samples. Samples were scanned with a MRI (3T, T1W turbo spin echo sequence, TR/TE 25/3.5ms, voxel size 0.22×0.22×0.50 mm, scan time 11:18). Micro-CT was used as control group (80kV, 125mA, voxel size 16µm). Artifacts' distribution was measured at vestibular and lingual sites, mesial and distal sites, and at the apex. Statistical analysis was performed with Within-ANOVA (p=0.05).

RESULTS

Artifacts distribution measured 2.57 ± 1.09 mm for titanium artifacts and 0.37 ± 0.20 mm for zirconia artifacts (p<0.05). Neither the measured sites (p=0.73) nor the implant geometries (p=0.43) influenced the appearance of artifacts.

CONCLUSION

Artifacts were higher for titanium than zirconia implants. The artifacts pattern was similar for different dental implant geometries.

Unwanted effects due to interactions between dental materials and magnetic resonance imaging: a review of the literature

Magnetic resonance imaging (MRI) is an advanced diagnostic tool used in both medicine and dentistry. Since it functions based on a strong uniform static magnetic field and radiofrequency pulses, it is advantageous over imaging techniques that rely on ionizing radiation. Unfortunately, the magnetic field and radiofrequency pulses generated within the magnetic resonance imager interact unfavorably with dental materials that have magnetic properties. This leads to unwanted effects such as artifact formation, heat generation, and mechanical displacement. These are a potential source of damage to the oral tissue surrounding the affected dental materials. This review aims to compile, based on the current available evidence, recommendations for dentists and radiologists regarding the safety and appropriate management of dental materials during MRI in patients with orthodontic appliances, maxillofacial prostheses, dental implants, direct and indirect restorative materials, and endodontic materials.

A Silk Cranial Fixation System for Neurosurgery

Cranial fixation should be safe, reliable, ideally degradable, and produce no hazardous residues and no artifacts on neuroimaging. Protein-based fixation devices offer an exciting opportunity for this application. Here, the preclinical development and in vivo efficacy verification of a silk cranial fixation system in functional models are reported by addressing key challenges toward clinical use. A comprehensive study on this fixation system in rodent and canine animal models for up to 12 months is carried out. The silk fixation system shows a superb performance on the long-term stability of the internal structural support for cranial flap fixation and bone reconnection and has good magnetic resonance imaging compatibility, and tolerability to high dose radiotherapy, underscoring the favorable clinical application of this system for neurosurgery compared to the current gold standard.

Magnetic permeability as a predictor of the artefact size caused by orthodontic appliances at 1.5 T magnetic resonance imaging

OBJECTIVES

Artefacts caused by orthodontic attachments limit the diagnostic value and lead to removal of these appliances before magnetic resonance imaging. Magnetic permeability can predict the artefact size. There is no standardised approach to determine the permeability of such attachments. The aim was to establish a reliable approach to determine artefact size caused by orthodontic attachments at 1.5 T MRI.

MATERIALS AND METHODS

Artefact radii of 21 attachments were determined applying two prevalent sequences of the head and neck region (turbo spin echo and gradient echo). The instrument Ferromaster (Stefan Mayer Instruments, Dinslaken) is approved for permeability measurements of objects with a minimum size (d = 20 mm, h = 5 mm). Eleven small test specimens of known permeability between 1.003 and 1.431 were produced. They are slightly larger than the orthodontic attachments. Their artefacts were measured and cross tabulated against the permeability. The resulting curve was used to compare the orthodontic attachments with the test bodies.

RESULTS

Steel caused a wide range of artefact size of 10-74 mm subject to their permeability. Titanium, cobalt-chromium and ceramic materials produced artefact radii up to 20 mm. Measurement of artefacts of the test bodies revealed an interrelationship according to a root function. The artefact size of all brackets was below that root function.

CONCLUSIONS

The permeability can be reliably assessed by conventional measurement devices and the artefact size can be predicted. The radiologist is able to decide whether or not the orthodontic attachments should be removed.

CLINICAL RELEVANCE

This study clarifies whether an orthodontic appliance must be removed before taking an MRI.

MRI with intraoral orthodontic appliance-a comparative in vitro and in vivo study of image artefacts at 1.5 T

OBJECTIVES

We investigated artefacts caused from orthodontic appliances at 1.5-T MRI of the head and neck region and whether the image quality can be improved utilizing the artefact-minimizing sequence WARP.

METHODS

In vitro tests were performed by phantom measurements of different orthodontic devices applying different types of MR sequences [echoplanar imaging (EPI), turbo spin echo (TSE) and TSE-WARP, gradient echo (GRE)]. Two independent readers determined after calibration the level of artefacts. Subsequently, the interobserver agreement was calculated. The measurement of artefacts was based on the American Society for Testing Materials Standard F 2119-07. For in vivo imaging, one test person was scanned with an inserted multibracket appliance. The level of artefacts for 27 target regions was evaluated.

RESULTS

In vitro: ceramic brackets and ferromagnetic steel brackets produced artefact radii up to 1.12 and 7.40 cm, respectively. WARP reduced these artefacts by an average of 32.7%. The Bland-Altman-Plot indicated that maximum measurement differences of 3 mm have to be expected with two calibrated observers. In vivo: the EPI sequence for brain imaging was not analysable. The TSE sequence of the brain did not demonstrate artefacts except for the nasal cavity. Conversely, the TSE sequence of the cervical spine revealed severe artefacts in the midface region. The GRE sequence appeared to be more susceptible to artefacts than did the TSE sequence.

CONCLUSIONS

In vitro measurements allow an estimation of the in vivo artefact size. Orthodontic appliances may often remain intraorally when performing MRI. WARP showed a more significant effect in vitro than in vivo.