Name: protocol for the evaluation of mri artifacts caused by metal implants to assess the suitability of implants and the vulnerability of pulse sequences
Uploaded: 2018-05-17T14:00:00
Description: Watch this Scientific Journal Video about Protocol for the Evaluation of MRI Artifacts Caused by Metal Implants to Assess the Suitability of Implants and the Vulnerability of Pulse Sequences at JoVE.c

The authors like to thank Stefanie Sauer, pharmacist at the Department of Pharmacy Heidelberg University Hospital, for her contributions to the MRI phantom. In addition, we would like to thank NORAS MRI products GmbH (H&#246;chberg, Germany) and especially Daniel Gareis for providing a prototype of the 16-channel multipurpose coil. Furthermore, we are grateful for the kind cooperation with SIEMENS Healthcare GmbH (Erlangen, Germany) and especially Mathias Nittka for their assistance in the sequence setup.

1. Phantom Preparation
<ol>
	<li>Determine the implant volume (e.g., by using the water displacement method). 
	NOTE: The volume of the CCT-T sample and the Z-T sample measured 0.65 mL and 0.73 mL, respectively.</li>
	<li>Fix the implant position in the middle of a non-ferromagnetic, plastic, waterproof box by using a thin thread. Use a box that is larger than the expected MRI artifacts. 
	NOTE: If no rough estimates of the artifact volumes of the implant and/or pulse sequence of interest are availab...

<ol>
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The number of patients with metallic implants and the number of MRI examinations is currently increasing1,2,3. In the past, MRI examinations were avoided after joint replacements. Today, however, MRI is not only requested for imaging such patients but should also allow for the evaluation of complications directly adjacent to joint arthroplasty. Thus, the MRI safety and MRI suitability of implants, as well as the robust pulse seq...

MRI has become an indispensable diagnostic tool. As a result, the number of MRI systems used in routine diagnostics is further increasing1. At the same time, the number of patients with implants is increasing as well2,3. In 2012, for instance, more than 1 million knee and joint replacements have been performed in the USA alone4. The prevalence of such implants was about 7 million in 2010, which corresponds to more than 10% of females in the age group 80-89 years5. As a result, the image quality and the diagnostic significance of MRI examinations are often impaired by artifacts due to metallic implants, resulting in a decreased diagnostic accuracy. Therefore, the MRI suitability of implants and the artifact vulnerability of pulse sequences are becoming increasingly important. Numerous approaches have been published to evaluate these characteristics. Due to strong discrepancies in the used evaluation methods, however, the respective results are hard to compare.
An evaluation of the MRI suitability of materials can be performed by calculating their magnetic susceptibility6. However, the vulnerability of different pulse sequences to artifacts cannot be compared with that approach for a given implant. Vice versa, the artifact volumes for a given pulse sequence can only be roughly estimated for different implants. In addition, the analysis is often performed with artificially shaped implants7,8. As the material volume and shape have an influence on the artifact size6, these features should be taken into account as well. As an alternative to magnetic susceptibility, the artifact size can be evaluated. Frequently, studies only rely on the qualitative evaluation of the artifact size9 or focus on the two-dimensional artifact size only covering one slice of the implant artifact10,11. Moreover, manual segmentation approaches are often used, which is not only time-consuming but also prone to intra- and inter-reader differences11. Finally, protocols often do not allow to test for non-fat-saturated and fat-saturated sequences at the same time12. This, however, would be desirable, since the applied fat suppression technique profoundly affects the artifact size.
Here, we present a protocol which allows for the reliable, semiautomatic, threshold-based, three-dimensional quantification of signal loss and pile-up artifacts of the entire implant, or all slices containing visible implant artifacts. Furthermore, it allows for testing T1- and T2-weighted images with or without fat-saturation. The protocol can be used to evaluate the MRI suitability of different implants or the vulnerability of different pulse sequences to metallic artifacts for a given implant.

<table border="0" cellpadding="0" cellspacing="0" width="638">
	<tbody>
		<tr height="21">
			<td height="21" style="height:21px;width:151px;">Aqua B. Braun Ecotainer</td>
			<td style="width:288px;">B. Braun Melsungen AG, Melsungen, Germany</td>
			<td style="width:136px;"></td>
			<td style="width:64px;"></td>
		</tr>
		<tr height="33">
			<td height="33" style="height:33px;width:151px;">Semisynthetic fat: Witepsol W25</td>
			<td style="width:288px;">Caelo Caesar &#38; Loretz GmbH, Hilder, Germany</td>
			<td style="width:136px;">4051</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:151px;">Macrogol-8-stearate</td>
			<td style="width:288px;">Caelo Caesar &#38; Loretz GmbH, Hilder, Germany</td>
			<td style="width:136px;">3023</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:151px;">Plastic box: not specified</td>
			<td style="width:288px;"></td>
			<td style="width:136px;"></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:151px;">Implants: Nobel Replace</td>
			<td>Nobel Biocare, Z&#252;rich, Switzerland</td>
			<td style="width:136px;"></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:151px;">Water bath Haake S5P</td>
			<td style="width:288px;">Thermo Scientific, Waltham, MA, USA</td>
			<td style="width:136px;"></td>
			<td></td>
		</tr>
		<tr height="52">
			<td height="52" style="height:52px;width:151px;">Measuring cylinder Blaubrand Eterna, Class A, Boro 3.3</td>
			<td style="width:288px;">BRAND GmbH + Co Kg, Wertheim, Germany</td>
			<td style="width:136px;">32708</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:151px;">Coil: Variety</td>
			<td style="width:288px;">Noras MRI products GmbH, H&#246;chberg, Germany</td>
			<td style="width:136px;"></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:151px;">MRI: Magnetom Trio</td>
			<td style="width:288px;">Siemens Healthcare GmbH, Erlangen, Germany</td>
			<td style="width:136px;"></td>
			<td></td>
		</tr>
		<tr height="35">
			<td height="35" style="height:35px;width:151px;">Postprocesing software: Amira 6.4</td>
			<td style="width:288px;">Thermo Scientific, Waltham, MA, USA</td>
			<td style="width:136px;"></td>
			<td></td>
		</tr>
	</tbody>
</table>

protocol for the evaluation of mri artifacts caused by metal implants to assess the suitability of implants and the vulnerability of pulse sequences

As the number of magnetic resonance imaging (MRI) scanners and patients with medical implants is constantly growing, radiologists increasingly encounter metallic implant-related artifacts in MRI, resulting in reduced image quality. Therefore, the MRI suitability of implants in terms of artifact volume, as well as the development of pulse sequences to reduce image artifacts, are becoming more and more important. Here, we present a comprehensive protocol which allows for a standardized evaluation of the artifact volume of implants on MRI. Furthermore, this protocol can be used to analyze the vulnerability of different pulse sequences to artifacts. The proposed protocol can be applied to T1- and T2-weighted images with or without fat-suppression and all passive implants. Furthermore, the procedure enables the separate and three-dimensional identification of signal loss and pile-up artifacts. As previous investigations differed greatly in evaluation methods, the comparability of their results was limited. Thus, standardized measurements of MRI artifact volumes are necessary to provide better comparability. This may improve the development of the MRI suitability of implants and better pulse sequences to finally improve patient care.

With the above-mentioned protocol, we evaluated the artifact volume of 2 different dental implants made of Titanium (T; see the Table of Materials) supporting different crowns [porcelain-fused-to-metal non-precious alloy (CCT-T) and monolithic zirconia (Z-T); Figure 1b and 1c]. The CCT-T sample represents a highly paramagnetic material composition predicting large artifacts (Cobalt 61%, Chrome 21%, and Tungsten 11%; CCT). The...

Watch this Scientific Journal Video about Protocol for the Evaluation of MRI Artifacts Caused by Metal Implants to Assess the Suitability of Implants and the Vulnerability of Pulse Sequences at JoVE.c

Protocol for the Evaluation of MRI Artifacts Caused by Metal Implants to Assess the Suitability of Implants and the Vulnerability of Pulse Sequences

We describe a standardized method to evaluate magnetic resonance imaging artifacts caused by implants to estimate the suitability of the implants for magnetic resonance imaging and/or the vulnerability of different pulse sequences to metallic artifacts simultaneously.

As the number of magnetic resonance imaging (MRI) scanners and patients with medical implants is constantly growing, radiologists increasingly encounter ...

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