A standardized evaluation of artefacts from metallic compounds during fast MR imaging

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.

SEMAC + VAT for Suppression of Artifacts Induced by Dental-Implant-Supported Restorations in Magnetic Resonance Imaging

The purpose of this study was to assess the feasibility of SEMAC + VAT to reduce artifacts induced by dental implant-supported restorations, such as its impact on the image quality. Dental-implant supported restorations were installed in a dry mandible. Magnetic resonance scans were acquired on a 3-Tesla MRI system. Artifact suppression (SEMAC + VAT) was applied with different intensity modes (weak, moderate, strong). Artifacts assessment was performed by measuring the mandible volume increase in MRI images prior (reference dataset) and after installation of dental implant-supported prosthesis. Image quality was assessed by two examiners using a five-point scale. Inter-examiner concordance and correlation analysis was performed with Cronbach's alpha and Spearman's test with a significance level at p = 0.05. Mandible volume increased by 60.23% when no artifact suppression method was used. By applying SEMAC + VAT, the volume increase ranged from 17.13% (strong mode) to 32.77% (weak mode). Visualization of mandibular bone was positively correlated with SEMAC intensity degree. SEMAC + VAT reduced MRI artifacts caused by dental-implant supported restorations. A stronger suppression mode improved visualization of mandibular bone in detriment of the scanning time.

The effect of metallic dental restorations and implants in causing patient discomfort and artefacts during magnetic resonance imaging of the head and neck

Context

Patients with metallic dental objects in their oral cavity are often associated with discomfort or artefacts during magnetic resonance imaging (MRI) of the head and neck.

Aim

This study was conducted to evaluate the effects of metallic dental objects in causing patient discomfort and artefacts during MRI of the head and neck region.

Design

This is an observational study including 538 participants from various specialized MRI centres in Kozhikode.

Methods and Material

MRI records of 538 participants who underwent head and neck MRI as a part of their medical treatment were collected. With the help of questionnaire and clinical examination, the type of metallic dental object in the patient's oral cavity was identified. After examining the MRI images, four categories of artefacts were established. In MRI brain, artefacts in three different sequences were also studied.

Statistical Analysis Used

The significance of the difference between proportions was analysed by the Chi-square test.

Results

Artefacts were found in 65 cases with metallic dental objects but none of the participants had experienced any kind of discomfort. The artefact formation significantly depended on the type of metallic dental restoration in the patient's oral cavity. Orthodontic braces and titanium bone plate created severe artefacts in head and neck MRI making interpretation almost impossible. In the MRI brain, diffusion-weighted imaging is most sensitive to artefact followed by fluid-attenuated inversion recovery.

Conclusions

Artefacts were found in 65 cases with metallic dental restorations but none of the participants had experienced any kind of discomfort.

Performance of PROPELLER FSE T2WI in reducing metal artifacts of material porcelain fused to metal crown: a clinical preliminary study

This study aimed to compare MRI quality between conventional fast spin echo T₂ weighted imaging (FSE T₂WI) with periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER) FSE T₂WI for patients with various porcelain fused to metal (PFM) crown and analyze the value of PROPELLER technique in reducing metal artifacts. Conventional FSE T₂WI and PROPELLER FSE T₂WI sequences for axial imaging of head were applied in participants with different PFM crowns: cobalt-chromium (Co–Cr) alloy, pure titanium (Ti), gold–palladium (Au–Pd) alloy. Two radiologists evaluated overall image quality of section in PFM using a 5-point scale qualitatively and measured the maximum artifact area and artifact signal-to-noise ratio (SNR) quantitatively. Fifty-nine participants were evaluated. The metal crown with the least artifacts and the optimum image quality shown in conventional FSE T₂WI and PROPELLER FSE T₂WI were in Au–Pd alloy, Ti, and Co–Cr alloy order. PROPELLER FSE T₂WI was superior to conventional FSE T₂WI in improving image quality and reducing artifact area for Co-Cr alloy (17.0 ± 0.2% smaller artifact area, p < 0.001) and Ti (11.6 ± 0.7% smaller artifact area, p = 0.005), but had similar performance compared to FSE T₂WI for Au–Pd alloy. The SNRs of the tongue and masseter muscle were significantly higher on PROPELLER FSE T₂WI compared with conventional FSE T₂WI (tongue: 29.76 ± 8.45 vs. 21.54 ± 9.31, p = 0.007; masseter muscle: 19.11 ± 8.24 vs. 15.26 ± 6.08, p = 0.016). Therefore, the different PFM crown generate varying degrees of metal artifacts in MRI, and the PROPELLER can effectively reduce metal artifacts especially in the PFM crown of Co-Cr alloy.

Dental management in head and neck cancers: from intensity-modulated radiotherapy with photons to proton therapy

INTRODUCTION

Despite reduction of xerostomia with intensity-modulated compared to conformal X-ray radiotherapy, radiation-induced dental complications continue to occur. Proton therapy is promising in head and neck cancers to further reduce radiation-induced side-effects, but the optimal dental management has not been defined.

MATERIAL AND METHODS

Dental management before proton therapy was assessed compared to intensity-modulated radiotherapy based on a bicentric experience, a literature review and illustrative cases.

RESULTS

Preserved teeth frequently contain metallic dental restorations (amalgams, crowns, implants). Metals blur CT images, introducing errors in tumour and organ contour during radiotherapy planning. Due to their physical interactions with matter, protons are more sensitive than photons to tissue composition. The composition of restorative materials is rarely documented during radiotherapy planning, introducing dose errors. Manual artefact recontouring, metal artefact-reduction CT algorithms, dual or multi-energy CT and appropriate dose calculation algorithms insufficiently compensate for contour and dose errors during proton therapy. Physical uncertainties may be associated with lower tumour control probability and more side-effects after proton therapy. Metal-induced errors should be quantified and removal of metal restorations discussed on a case by case basis between dental care specialists, radiation oncologists and physicists. Metallic amalgams can be replaced with water-equivalent materials and crowns temporarily removed depending on rehabilitation potential, dental condition and cost. Implants might contraindicate proton therapy if they are in the proton beam path.

CONCLUSION

Metallic restorations may more severely affect proton than photon radiotherapy quality. Personalized dental care prior to proton therapy requires multidisciplinary assessment of metal-induced errors before choice of conservation/removal of dental metals and optimal radiotherapy.

Susceptibility artifacts induced by crowns of different materials with prepared teeth and titanium implants in magnetic resonance imaging

This study aimed to investigate the artifacts induced by crowns composed of different materials with prepared teeth and titanium implants. Resin, metal-ceramic, ceramic and zirconia crowns were fabricated and placed onto the prepared teeth on a human cadaver head or titanium implants with prosthesis abutments on a dry human mandible. The samples were scanned on a 1.5 T MRI apparatus, and artifact areas were defined as the signal intensity and signal loss adjacent to the prosthesis and measured by a threshold tool with ImageJ2x. Data were analyzed using SPSS 22.0. Resin, ceramic, zirconia, and precious metal-ceramic crowns barely produced artifacts on the cadaver skull (p > 0.999). By contrast, pure Ti and nonprecious metal-ceramic crowns created significant artifacts (p < 0.001). The average artifacts reduction of double Au-Pt and Ag-Pd metal-ceramic crowns combined with titanium implants and abutments was 79.49 mm² (p < 0.001) and 74.17 mm² (p < 0.001) respectively, while artifact areas were increased in double Co-Cr and Ni–Cr metal-ceramic crowns by 150.10 mm² (p < 0.001) and 175.50 mm² (p < 0.001) respectively. Zirconia, ceramic and precious metal-ceramic crowns induce less MRI artifacts after tooth preparation while precious metal-ceramic crowns alleviate artifacts in combination with titanium implants.

MRI Compatible, Customizable, and 3D-Printable Microdrive for Neuroscience Research

The effective connectivity of brain networks can be assessed using functional magnetic resonance imaging (fMRI) to quantify the effects of local electrical microstimulation (EM) on distributed neuronal activity. The delivery of EM to specific brain regions, particularly with layer specificity, requires MRI compatible equipment that provides fine control of a stimulating electrode's position within the brain while minimizing imaging artifacts. To this end, we developed a microdrive made entirely of MRI compatible materials. The microdrive uses an integrated penetration grid to guide electrodes and relies on a microdrilling technique to eliminate the need for large craniotomies, further reducing implant maintenance and image distortions. The penetration grid additionally serves as a built-in MRI marker, providing a visible fiducial reference for estimating probe trajectories. Following the initial implant procedure, these features allow for multiple electrodes to be inserted, removed, and repositioned with minimal effort, using a screw-type actuator. To validate the design of the microdrive, we conducted an EM-coupled fMRI study with a male macaque monkey. The results verified that the microdrive can be used to deliver EM during MRI procedures with minimal imaging artifacts, even within a 7 Tesla (7T) environment. Future applications of the microdrive include neuronal recordings and targeted drug delivery. We provide computer aided design (CAD) templates and a parts list for modifying and fabricating the microdrive for specific research needs. These designs provide a convenient, cost-effective approach to fabricating MRI compatible microdrives for neuroscience research.

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.

Quantification of metal-induced susceptibility artifacts associated with ultrahigh-field magnetic resonance imaging of spinal implants

Reports on spinal-implant metallic artifacts in 7-T magnetic resonance imaging (MRI) are lacking. Thus, we investigated the magnitude of metal artifacts derived from spinal implants in 7-T MRI and analyzed the differences obtained with spinal rods manufactured from pure titanium, titanium alloy, and cobalt-chrome (5.5-mm and 6.0-mm diameters and 50-mm length). Following the American Society for Testing and Materials guidelines, we measured the artifact size and artifact volume ratio of each rod during image acquisition using 7-T MRI scanners with three-dimensional (3D) T1-weighted and 3D T2* spoiled gradient echo (GRE), 3D T2-weighted fast spin echo, zero echo time (ZTE), and diffusion-weighted imaging sequences. Pure titanium and titanium alloy rods yielded significantly smaller artifacts than did cobalt-chrome rods, with no significant difference between pure titanium and titanium alloy rods. The artifact sizes of the 5.5-mm and 6.0-mm diameter rods were similar. The artifact magnitude increased in the following sequence order: ZTE, 3D T2 fast spin echo, 3D T1 spoiled GRE, 3D T2* spoiled GRE, and diffusion-weighted imaging. Artifacts obtained using the spin echo method were smaller than those obtained with the GRE method. Because the echo time in ZTE is extremely short, the occurrence of artifacts because of image distortion and signal loss caused by differences in magnetic susceptibility is minimal, resulting in the smallest artifacts. ZTE can be a clinically useful method for the postoperative evaluation of patients after instrumentation surgery, even with 7-T MRI.

Quantitative evaluation of artefact reduction from metallic dental materials in short tau inversion recovery imaging: efficacy of syngo WARP at 3.0 tesla

OBJECTIVES

To evaluate the effects of syngo WARP on reducing metal artefacts from dental materials.

METHODS

Short tau inversion recovery (STIR) with syngo WARP [a dedicated metal artefact reduction sequence in combination with view-angle-tilting (VAT)] was performed using phantoms of three dental alloys: cobalt-chromium (Co-Cr), nickel-chromium (Ni-Cr), and titanium (Ti). Artefact volumes and reduction ratios of black, white and overall artefacts in the standard STIR and syngo WARP images with several different parameter settings were quantified according to standards of the American Society for Testing and Materials F2119-07. In all sequences, the artefact volumes and reduction ratios were compared. The modulation transfer function (MTF) and contrast-to-noise ratio (CNR) were also measured for evaluation of image quality.

RESULTS

In standard STIR, the overall artefact volume of Co-Cr was markedly larger than those of Ni-Cr and Ti. All types of artefacts tended to be reduced with increasing receiver bandwidth (rBW) and VAT. The effect of artefact reduction tended to be more obvious in the axial plane than in the sagittal plane. Compared with standard STIR, syngo WARP with a matrix of 384 × 384, receiver bandwidth of 620 Hz/pixel, and VAT of 100 % in the axial plane obtained reduction effects of 30 % (white artefacts), 45 % (black artefacts), and 38 % (overall artefacts) although MTF and CNR decreased by 30 and 22 % compared with those of standard STIR, respectively.

CONCLUSIONS

syngo WARP for STIR can effectively reduce metal artefacts from dental materials.

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 quantitative experimental phantom study on MRI image uniformity

OBJECTIVES

Our goal was to assess MR image uniformity by investigating aspects influencing said uniformity via a method laid out by the National Electrical Manufacturers Association (NEMA).

METHODS

Six metallic materials embedded in a glass phantom were scanned (i.e. Au, Ag, Al, Au-Ag-Pd alloy, Ti and Co-Cr alloy) as well as a reference image. Sequences included spin echo (SE) and gradient echo (GRE) scanned in three planes (i.e. axial, coronal, and sagittal). Moreover, three surface coil types (i.e. head and neck, Brain, and temporomandibular joint coils) and two image correction methods (i.e. surface coil intensity correction or SCIC, phased array uniformity enhancement or PURE) were employed to evaluate their effectiveness on image uniformity. Image uniformity was assessed using the National Electrical Manufacturers Association peak-deviation non-uniformity method.

RESULTS

Results showed that temporomandibular joint coils elicited the least uniform image and brain coils outperformed head and neck coils when metallic materials were present. Additionally, when metallic materials were present, spin echo outperformed gradient echo especially for Co-Cr (particularly in the axial plane). Furthermore, both SCIC and PURE improved image uniformity compared to uncorrected images, and SCIC slightly surpassed PURE when metallic metals were present. Lastly, Co-Cr elicited the least uniform image while other metallic materials generally showed similar patterns (i.e. no significant deviation from images without metallic metals).

CONCLUSIONS

Overall, a quantitative understanding of the factors influencing MR image uniformity (e.g. coil type, imaging method, metal susceptibility, and post-hoc correction method) is advantageous to optimize image quality, assists clinical interpretation, and may result in improved medical and dental care.