Comparing Metal Artifact Severity and Ability to Assess Near-Metal Anatomy Between 0.55 T and 1.5 T MRI in Patients with Metallic Spinal Implants-A Scanner Comparison Study

Acad Radiol. 2024 Jun;31(6):2456-2463. doi: 10.1016/j.acra.2023.12.048. Epub 2024 Jan 18.

Abstract

Rationale and objectives: To compare image quality and metal artifact severity at 0.55 T and 1.5 T MRI in patients with spinal implants following posterior fusion surgery.

Materials and methods: 50 consecutive patients (mean age: 69 ± 12 years) who underwent 0.55 T and 1.5 T MRI following posterior fusion surgery of the lumbar or thoracolumbar spine were included. Examinations used metal artifact reduction protocols from clinical routine. Images were rated by two fellowship-trained musculoskeletal radiologists for image quality, ability to assess the spinal canal and the neural foramina, and artifact severity on 5-point Likert scales. Additionally, differences in artifact severity and visibility of near-metal anatomy among implant sizes (1-level vs. 2-level vs. >2-levels) were evaluated.

Results: Signal/contrast (mean: 4.0 ± 0.3 [0.55 T] vs. 4.4 ± 0.6 [1.5 T]; p < .001) and resolution (3.8 ± 0.5 vs. 4.2 ± 0.7; p < .001) were rated lower at 0.55 T. The ability to assess the spinal canal (4.4 ± 0.5 vs. 4.2 ± 0.9; p = .69) and the neural foramina (3.8 ± 0.5 vs. 3.8 ± 0.9; p = .19) were however rated equally good with excellent interrater agreement (range: 0.84-0.94). Susceptibility artifacts were rated milder at 0.55 T (1.8 ± 0.5 vs. 3.0 ± 0.6; p < .001). For implant size-based subgroups, the visibility of near-metal anatomy decreased with implant length at 1.5 T, but remained unchanged at 0.55 T. In consequence, the spinal canal and neural foramina could be better assessed at 0.55 T in patients with multi-level implants (4.4 ± 0.5 vs. 3.6 ± 1.1; p < .001).

Conclusion: Metal artifacts of spinal implants are substantially less pronounced at 0.55 T MRI. When examining patients with multi-level posterior fusion, this translates into a superior ability to assess near-metal anatomy, where 1.5 T MRI reaches diagnostic limitations.

Keywords: Artifacts; Low-Field MRI; Lumbar Spine; Magnetic Resonance Imaging; Metal.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Artifacts*
  • Female
  • Humans
  • Magnetic Resonance Imaging* / methods
  • Male
  • Metals*
  • Middle Aged
  • Prostheses and Implants*
  • Spinal Fusion / instrumentation
  • Spinal Fusion / methods

Substances

  • Metals