Download PDF
Semin Musculoskelet Radiol 2002; 06(1): 005-018
DOI: 10.1055/s-2002-23160
Copyright © 2002 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Technical Considerations: CT and MR Imaging in the Postoperative Orthopedic Patient

Lawrence M. White1 , Kenneth A. Buckwalter2
  • 1Department of Medical Imaging, Division of Musculoskeletal Imaging, University of Toronto, Mount Sinai Hospital and the University Health Network, Toronto, Ontario, Canada
  • 2Section of Musculoskeletal Imaging, Department of Radiology, Indiana University Hospital, Indianapolis, IN
Further Information

Publication History

Publication Date:
26 March 2002 (online)

Also available at
    Permissions and Reprints

ABSTRACT

Cross-sectional imaging utilizing computed tomography (CT) and magnetic resonance (MR) imaging have become routine components in the imaging assessment of patients with musculoskeletal disease. Unfortunately, in the setting of a postoperative orthopedic patient with associated orthopedic metallic instrumentation, these imaging techniques are prone to artifacts resulting in image quality degradation. An understanding of the physical basis of such metal-related artifacts, and their appearance on CT and MR imaging, has led investigators to the implementation of a series of techniques and modifications to imaging protocols to decrease CT and MR imaging artifacts in the vicinity of metallic instrumentation. Utilizing such modified imaging techniques, consistent, improved CT and MR image quality may be achieved in imaging of the postoperative orthopedic patient.

KEYWORD

Computed tomography - magnetic resonance imaging - orthopedic instrumentation - artifacts

REFERENCES

  • 1 Shellock F G, Morisoli S, Kanal E. MR procedures and biomedical implants, materials, and devices: 1993 update.  Radiology . 1993;  189 587-559
    CrossrefPubMedGoogle Scholar
  • 2 Wang J C, Yu W D, Sandhu H S, Tam V, Delamarter R B. A comparison of magnetic resonance and computed tomographic image quality after the implantation of tantalum and titanium spinal instrumentation.  Spine . 1988;  23 1684-1688
    PubMedGoogle Scholar
  • 3 Ebraheim N A, Coombs R, Rusin J J, Jackson W T. Reduction of post-operative CT artifacts of pelvic fractures by use of titanium implants.  Orthopedics . 1990;  13 1357-1358
    PubMedGoogle Scholar
  • 4 Haramati N, Staron R B, Mazel-Sperling K, Freeman K, Nickoloff E L, Barax C, Feldman F. CT scans through metal scanning technique versus hardware composition.  Comput Med Imag Graph . 1994;  18 429-434
    CrossrefPubMedGoogle Scholar
  • 5 Brown J H, Lustrin E S, Lev M H, Ogilvy C S, Taveras J M. Reduction of aneurysm clip artifacts on CT angiograms: a technical note.  Am J Neuroradiol . 1999;  20 694-696
    PubMedGoogle Scholar
  • 6 Robertson D D, Weiss P J, Fishman E K, Magid D, Walker P S. Evaluation of CT techniques for reducing artifacts in the presence of metallic orthopedic implants.  J Comput Assist Tomog . 1988;  12 236-241
    CrossrefPubMedGoogle Scholar
  • 7 Link T M, Berning W, Scherf S, Joosten U, Joist A, Engelke K, DaldrupLink H E. CT of metal implants: reduction of artifacts using an extended CT scale technique.  J Comput Assist Tomog . 2000;  24 165-172
    CrossrefPubMedGoogle Scholar
  • 8 Fishman E K, Magid D, Robertson D D, Brooker A F, Weiss P, Siegelman S S. Metallic hip implants: CT with multiplanar reconstruction.  Radiology . 1986;  160 675-681
    PubMedGoogle Scholar
  • 9 Hinderling T H, Rüegsegger P, Anliker M, Dietschi C. Computed tomography reconstruction from hollow projections: an application to in vivo evaluation of artificial hip joints.  J Comput Assist Tomog . 1979;  3 52-57
    PubMedGoogle Scholar
  • 10 Kalender W A, Hebel R, Ebersberger J. Reduction of artifacts caused by metallic implants.  Radiology . 1987;  164 576-577
    PubMedGoogle Scholar
  • 11 Robertson D D, Yuan J, Wang G, Vannier M W. Total hip prosthesis metal-artifact suppression using iterative deblurring reconstruction.  J Comput Assist Tomog . 1997;  21 293-298
    PubMedGoogle Scholar
  • 12 Wang G, Frei T, Vannier M W. Fast iterative algorithm for metal artifact reduction in X-ray CT.  Acad Radiol . 2000;  7 607-614
    PubMedGoogle Scholar
  • 13 Zhao S, Robertson D D, Wang G, Whiting B, Bae K T. X-ray CT metal artifact reduction using wavelets: an application for imaging total hip prostheses.  IEEE Trans Med Imag . 2000;  19 1238-1247
    PubMedGoogle Scholar
  • 14 White L M, Kim J K, Mehta M. Complications of total hip arthroplasty: MR imaging-initial experience.  Radiology . 2000;  215 254-262
    PubMedGoogle Scholar
  • 15 Tormanen J, Tervonen O, Koivula A, Junita J, Suramo I. Image technique optimization in MR imaging of a titanium alloy joint prosthesis.  J Magn Reson Imag . 1996;  6 805-811
    PubMedGoogle Scholar
  • 16 Henck C B, Brodner W, Grampp S, Breitenscher M, Thurnher M, Mostbeck G H, Imhof H. The postoperative spine.  Top Magn Reson Imag . 1999;  10 247-264
    PubMedGoogle Scholar
  • 17 Olsen R V, Munk P L, Lee M J, Janzen D L, MacKay A L, Xiang Q S, Masri B. Metal artifact reduction sequence: early clinical applications.  Radiographics . 2000;  20 699-712
    CrossrefPubMedGoogle Scholar
  • 18 Chang S D, Lee M J, Munk P L, Janzen D L, MacKay A, Xiang Q S. MRI of spinal hardware: comparison of conventional TI-weighted sequence with a new metal artifact reduction sequence.  Skel Radiol . 2001;  20 213-218
    PubMedGoogle Scholar
  • 19 Peterslige C A, Lewin J S, Duerk J L, Yoo J U, Ghaneyem A J. Optimizing imaging parameters for MR evaluation of the spine with titanium pedicle screws.  Am J Roentgenol . 1996;  166 1213-1218
    PubMedGoogle Scholar
  • 20 Czerny C, Krestan C, Imhof H, Trattnig S. Magnetic resonance imaging of the postoperative hip.  Top Magn Reson Imag . 1999;  10 214-220
    PubMedGoogle Scholar
  • 21 Frazzini V I, Kagetsu N J, Johnson C E, Destian S. Internally stabilized spine: optimal choice of frequency-encoding gradient direction during MR imaging minimizes susceptibility artifact from titanium vertebral body screws.  Radiology . 1997;  204 268-272
    PubMedGoogle Scholar
  • 22 Tartaglino L M, Flanders A E, Vitinski S, Friedman D P. Metallic artifacts on MR images of the postoperative spine: reduction with fast spin-echo techniques.  Radiology . 1994;  190 565-569
    PubMedGoogle Scholar
  • 23 Eustace S, Jara H, Goldberg R, Fenlon H, Mason M, Melhem E R, Yucel E K. A comparison of conventional spin-echo and turbo spin-echo imaging of soft tissue adjacent to orthopedic hardware.  Am J Roentgenol . 1998;  170 455-458
    PubMedGoogle Scholar
  • 24 Wendt R E, Wicott M R, Nitz W, Murphy P H, Bryan R N. MR imaging of susceptibility-induced magnetic field inhomogeneities.  Radiology . 1988;  168 837-841
    PubMedGoogle Scholar
  • 25 Bakker C JG, Bhagwandien R, Moerland M A, Fuderer M. Susceptibility artifacts in 2DFT spin-echo imaging: the cylinder model revisited.  Magn Reson Imag . 1993;  11 539-548
    PubMedGoogle Scholar
  • 26 Bakker C JG, Bhagwandien R, Moerland M A, Ramos L MP. Simulation of susceptibility artifacts in 2D and 3D Fourier transform spin-echo and gradient-echo magnetic resonant imaging.  Magn Reson Imag . 1994;  12 767-774
    CrossrefPubMedGoogle Scholar
  • 27 Mueller P R, Stark D D, Simeone J F. MR-guided aspiration biopsy: needle design and clinical trials.  Radiology . 1986;  161 605-609
    PubMedGoogle Scholar
  • 28 Suh J S, Jeong E K, Shin K H, Cho J H, Na J B, Kim D H, Han C D. Minimizing artifacts caused by metallic implants at MR imaging: experimental and clinical studies.  Am J Roentgenol . 1998;  171 1207-1213
    PubMedGoogle Scholar
  • 29 Sakurai K, Fujita N, Harada K, Kim S W, Nakanishi K, Kozuka T. Magnetic susceptibility artifact in spin-echo MR imaging of the pituitary gland.  Am J Neuroradiol . 1992;  13 1301-1308
    PubMedGoogle Scholar
  • 30 Sled J G, Pike G B. Correction for B1 and Bo variations in quantitative T2 measurements using MRI.  Magn Reson Med . 2000;  43 589-593
    CrossrefPubMedGoogle Scholar
  • 31 Hennig J. Clinical applications and methodological developments of the RARE technique.  Magn Reson Imag . 1988;  4 391-395
    PubMedGoogle Scholar
  • 32 Hilfiker P, Zanetti M, Debatin J F, McKinnon G, Hodler J. Fast spin-echo inversion-recovery imaging versus fast spin-echo imaging in bone marrow abnormalities.  Invest Radiol . 1995;  30 110-114
    CrossrefPubMedGoogle Scholar
      >