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Heinrich A, Reinhold M, Güttler FV, Matziolis G, Teichgräber UKM, Zippelius T, Strube P. MRI following scoliosis surgery? An analysis of implant heating, displacement, torque, and susceptibility artifacts. Eur Radiol 2020; 31:4298-4307. [PMID: 33277671 PMCID: PMC8128815 DOI: 10.1007/s00330-020-07546-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 10/21/2020] [Accepted: 11/19/2020] [Indexed: 12/01/2022]
Abstract
Objectives The implant constructs used in scoliosis surgery are often long with a high screw density. Therefore, it is generally believed that magnetic resonance imaging (MRI) should not be carried out after scoliosis surgery, with the result that computed tomography is often preferred despite the ionizing radiation involved. The objective of this study was to evaluate the MRI compatibility of long pedicle-screw-rod constructs at 1.5 T and 3 T using standardized methods of the American Society for Testing and Materials (ASTM). Methods Constructs between 130 and 430 mm long were systematically examined according to the ASTM standards F2182 (radio frequency–induced heating), F2119 (susceptibility artifacts), F2213 (magnetically induced torque), and F2052 (magnetically induced displacement force). Results The maximum heating in the magnetic field was 1.3 K. Heating was significantly influenced by magnetic field strength (p < 0.001), implant length (p = 0.048), and presence of cross-links (p = 0.001). The maximum artifact width for different lengths of the anatomically bent titanium rods with CoCr alloy ranged between 14.77 ± 2.93 mm (TSE) and 17.49 ± 1.82 mm (GRE) for 1.5 T and between 23.67 ± 2.39 mm (TSE) and 27.77 ± 2.37 mm (GRE) for 3 T. TiCP and TiAl showed the smallest and CoCr and CoCr Plus the largest artifact widths. The magnetically induced torque and displacement force were negligible. Conclusions MRI following scoliosis surgery with long implant constructs is safe with the patient in supine position. Although susceptibility artifacts can severely limit the diagnostic value, the examination of other regions is possible. Key Points • Large spinal implants are not necessarily a contraindication for MRI; MR conditional status can be examined according to the ASTM standards F2182, F2119, F2213, and F2052. • A metallic pedicle-screw-rod system could be reliably and safely examined in all combinations of length (130 to 430 mm), configuration, and material in a B0at 1.5 T and 3 T. • According to ASTM F2503, the examined pedicle-screw-rod system is MR conditional and especially the young patients can benefit from a non-ionizing radiation MRI examination.
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Affiliation(s)
- Andreas Heinrich
- Department of Radiology, Jena University Hospital - Friedrich Schiller University, Am Klinikum 1, 07747, Jena, Germany.
| | - Maximilian Reinhold
- Department of Radiology, Jena University Hospital - Friedrich Schiller University, Am Klinikum 1, 07747, Jena, Germany
| | - Felix V Güttler
- Department of Radiology, Jena University Hospital - Friedrich Schiller University, Am Klinikum 1, 07747, Jena, Germany
| | - Georg Matziolis
- Department of Orthopedics, Jena University Hospital, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany
| | - Ulf K-M Teichgräber
- Department of Radiology, Jena University Hospital - Friedrich Schiller University, Am Klinikum 1, 07747, Jena, Germany
| | - Timo Zippelius
- Department of Orthopedics, Jena University Hospital, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany
| | - Patrick Strube
- Department of Orthopedics, Jena University Hospital, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany
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Jones BG, Fosgate GT, Green EM, Habing AM, Hettlich BF. Magnetic resonance imaging susceptibility artifacts in the cervical vertebrae and spinal cord related to monocortical screw-polymethylmethacrylate implants in canine cadavers. Am J Vet Res 2017; 78:458-464. [PMID: 28346006 DOI: 10.2460/ajvr.78.4.458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To characterize and compare MRI susceptibility artifacts related to titanium and stainless steel monocortical screws in the cervical vertebrae and spinal cord of canine cadavers. SAMPLE 12 canine cadavers. PROCEDURES Cervical vertebrae (C4 and C5) were surgically stabilized with titanium or stainless steel monocortical screws and polymethylmethacrylate. Routine T1-weighted, T2-weighted, and short tau inversion recovery sequences were performed at 3.0 T. Magnetic susceptibility artifacts in 20 regions of interest (ROIs) across 4 contiguous vertebrae (C3 through C6) were scored by use of an established scoring system. RESULTS Artifact scores for stainless steel screws were significantly greater than scores for titanium screws at 18 of 20 ROIs. Artifact scores for titanium screws were significantly higher for spinal cord ROIs within the implanted vertebrae. Artifact scores for stainless steel screws at C3 were significantly less than at the other 3 cervical vertebrae. CONCLUSIONS AND CLINICAL RELEVANCE Evaluation of routine MRI sequences obtained at 3.0 T revealed that susceptibility artifacts related to titanium monocortical screws were considered mild and should not hinder the overall clinical assessment of the cervical vertebrae and spinal cord. However, mild focal artifacts may obscure small portions of the spinal cord or intervertebral discs immediately adjacent to titanium screws. Severe artifacts related to stainless steel screws were more likely to result in routine MRI sequences being nondiagnostic; however, artifacts may be mitigated by implant positioning.
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Dillenseger JP, Molière S, Choquet P, Goetz C, Ehlinger M, Bierry G. An illustrative review to understand and manage metal-induced artifacts in musculoskeletal MRI: a primer and updates. Skeletal Radiol 2016; 45:677-88. [PMID: 26837388 DOI: 10.1007/s00256-016-2338-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 01/13/2016] [Accepted: 01/17/2016] [Indexed: 02/02/2023]
Abstract
This article reviews and explains the basic physical principles of metal-induced MRI artifacts, describes simple ways to reduce them, and presents specific reduction solutions. Artifacts include signal loss, pile-up artifacts, geometric distortion, and failure of fat suppression. Their nature and origins are reviewed and explained though schematic representations that ease the understanding. Then, optimization of simple acquisition parameters is detailed. Lastly, dedicated sequences and options specifically developed to reduce metal artifacts (VAT, SEMAC, and MAVRIC) are explained.
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Affiliation(s)
- J P Dillenseger
- Medical imaging department, University Hospital of Strasbourg, 10 Av. Molière, F- 67098, Strasbourg, France.,Icube, CNRS, University of Strasbourg, Strasbourg, France.,Translational Medicine Research Federation, Strasbourg Medical School, University of Strasbourg, Strasbourg, France
| | - S Molière
- Medical imaging department, University Hospital of Strasbourg, 10 Av. Molière, F- 67098, Strasbourg, France
| | - P Choquet
- Medical imaging department, University Hospital of Strasbourg, 10 Av. Molière, F- 67098, Strasbourg, France.,Icube, CNRS, University of Strasbourg, Strasbourg, France.,Translational Medicine Research Federation, Strasbourg Medical School, University of Strasbourg, Strasbourg, France
| | - C Goetz
- Medical imaging department, University Hospital of Strasbourg, 10 Av. Molière, F- 67098, Strasbourg, France.,Icube, CNRS, University of Strasbourg, Strasbourg, France.,Translational Medicine Research Federation, Strasbourg Medical School, University of Strasbourg, Strasbourg, France
| | - M Ehlinger
- Icube, CNRS, University of Strasbourg, Strasbourg, France.,Translational Medicine Research Federation, Strasbourg Medical School, University of Strasbourg, Strasbourg, France.,Department of orthopedic surgery, University Hospital of Strasbourg, Strasbourg, France
| | - G Bierry
- Medical imaging department, University Hospital of Strasbourg, 10 Av. Molière, F- 67098, Strasbourg, France. .,Icube, CNRS, University of Strasbourg, Strasbourg, France. .,Translational Medicine Research Federation, Strasbourg Medical School, University of Strasbourg, Strasbourg, France.
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Chang CC, Wu CL, Wu JC, Chang HK, Fay LY, Tu TH, Huang WC, Cheng H. Letter to the Editor: Post-ACDF imaging in patients with metallic implants. J Neurosurg Spine 2016; 25:418-9. [PMID: 27129042 DOI: 10.3171/2016.1.spine1688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Chih-Chang Chang
- Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ching-Lan Wu
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jau-Ching Wu
- Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hsuan-Kan Chang
- Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Li-Yu Fay
- Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan
| | - Tsung-Hsi Tu
- Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Molecular Medicine Program, Taiwan International Graduate Program, Academia Sinica, Taipei, Taiwan
| | - Wen-Cheng Huang
- Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Henrich Cheng
- Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
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Qi S, Wu ZG, Mu YF, Gao LL, Yang J, Zuo PL, Nittka M, Liu Y, Wang HQ, Yin H. SEMAC-VAT MR Imaging Unravels Peri-instrumentation Lesions in Patients With Attendant Symptoms After Spinal Surgery. Medicine (Baltimore) 2016; 95:e3184. [PMID: 27057844 PMCID: PMC4998760 DOI: 10.1097/md.0000000000003184] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The study aimed for evaluating the diagnostic value of a 2D Turbo Spin Echo (TSE) magnetic resonance (MR) imaging sequence implanted slice-encoding metal artifact correction (SEMAC) and view-angle tilting (VAT) in patients with spinal instrumentation.Sixty-seven consecutive patients with an average age of 59.7 ± 17.8 years old (range: 32-75 years) were enrolled in this study. Both sagittal, axial T1-weighted and T2-weighted MRI images were acquired with a standard TSE sequence and a high-bandwidth TSE sequence implemented the SEMAC and VAT techniques. Three continuous sections around the instrumentation in axial and sagittal images were selected for quantitative evaluation. The measurement included cumulative areas of signal void on axial images and the length of spinal canal obscuration on sagittal images. Three radiologists independently evaluated all images blindly. The inter-observer reliability was evaluated with inter-class coefficient. We defined patients with discomfortable symptoms caused by spinal instrumentation as spinal instrumentation adverse reaction.Visualizations of all periprosthetic anatomic structures were significantly better for SEMAC-VAT compared with standard imaging. For axial images, the area of signal void at the level of the instrumentation were statistically reduced with SEMAC-VAT TSE sequences than with standard TSE sequences for T2-weighted images (9.9 ± 2.6 cm vs 29.8 ± 14.7 cm, P < 0.001). For sagittal imaging, the length of spinal canal obscuration at the level of the instrumentation was reduced from 5.2 ± 2.0 cm to 1.2 ± 0.6 cm on T2-weighted images (P < 0.001), and from 4.8 ± 2.1 cm to 1.1 ± 0.5 cm on T1-weighted images with SEMAC-VAT sequences (P < 0.001). Interobserver agreement for visualization of anatomic structures and image quality was good for both SEMAC-VAT (k = 0.77 and 0.68, respectively) and standard (k = 0.74 and 0.80, respectively) imaging. The number of abnormal findings noted on SEMAC images (59 findings) was significantly higher than detected on standard images (40 findings). The incidence rate of spinal instrumentation adverse reaction was 38.81%.MR images with SEMAC-VAT can significantly reduce metal artifacts for spinal instrumentation and improve delineation of the instrumentation and periprosthetic region. Furthermore, SEMAC-VAT technique can improve diagnostic accuracy in patients with post-instrumentation spinal diseases.
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Affiliation(s)
- Shun Qi
- From the Department of Radiology (SQ, LLG, YL, HY), Xijing Hospital, the Fourth Military Medical University, Xi'an, PR China; Department of Orthopaedics (ZGW), No. 518 Hospital of Chinese People's Liberation Army, Xi'an, PR China; Department of Orthopedics (ZGW), Lanzhou General Hospital of Lanzhou Military Region, People's Liberation Army, Lanzhou, PR China; Department of Radiotherapy (YFM), Xijing Hospital, the Fourth Military Medical University, Xi'an, PR China; Department of Radiology (SQ, JY), The First Affiliated Hospital of Medical College of Xi'an Jiaotong University, Xi'an, PR China; Siemens Healthcare (PLZ), MR Collaborations NE Asia, Beijing, PR China; Siemens Healthcare (MN), Erlangen, Germany; and Department of Orthopaedics (HQW), Xijing Hospital, The Fourth Military Medical University, Xi'an, PR China
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