title: Evaluation of MR issues for the latest standard brands of orthopedic metal implants: plates and screws.
abstract: OBJECTIVE
  The study was performed to evaluate magnetic resonance (MR) issues for the latest standard brands of plates and screws used in orthopedic surgery at a 1.5-T MR system, including the safety and metallic artifacts.
  
  
  METHODS
  The plates and screws (made of titanium alloy and stainless steel materials, according to the latest standard brands) were assessed for displacement in degrees, MRI-related heating and artifacts at a 1.5-T MR system. The displacement in degrees of the plates and screws was evaluated on an angel-measurement instrument at the entrance of the MR scanner. The MRI-related heating was assessed on a swine leg fixed with a plate by using a "worst-case" pulse sequence. A rectangular water phantom was designed to evaluate metallic artifacts of a screw on different sequences (T1/T2-weighted FSE, STIR, T2-FSE fat saturation, GRE, DWI) and then artifacts were evaluated on T2-weighted FSE sequence by modifying the scanning parameters including field of view (FOV), echo train length (ETL) and bandwidth to identify the influence of parameters on metallic artifacts. 15 volunteers with internal vertebral fixation (titanium alloy materials) were scanned with MR using axial and sagittal T2-FSE, sagittal T2-FSE fat suppression and STIR with conventional and optimized parameters, respectively. Then all images were graded by two experienced radiologists having the experience of more than 7 years under double-blind studies that is neither of them knew which was conventional parameter group and optimized parameter group.
  
  
  RESULTS
  The average deflection angle of titanium alloy and stainless steel implants were 4.3° and 7.7°, respectively, (less than 45°) which indicated that the magnetically induced force was less than the weight of the object. The deflection angle of the titanium alloy implants was less than the stainless steel one (t=9.69, P<0.001). The average temperature changes of titanium alloy before and after the scan was 0.48°C and stainless steel implants was 0.74°C, respectively, with the background temperature changes of 0.24°C. The water phantom test indicated that the DWI sequence produced largest artifacts, while FSE pulse sequence produced smallest artifacts. And T2-weighted FSE fat saturation sequence produced larger artifacts than STIR sequence. The influence of the scanning parameters on metallic artifacts was verified that metallic artifacts increased with longer echo train length and bigger FOV, while decreased with larger bandwidth. The interreader agreement was good or excellent for each set of images graded with Cohen's Kappa statistic. Image grading of axial and sagittal T2-FSE with optimized parameters were significantly superior to that with conventional parameters (grade, 3.3±0.5 vs 2.7±0.6, P=0.003; 3.2±0.4 vs 1.9±0.7, P=0.001) and image of STIR sequence received a better grade than T2-FSE FS sequence (grade, 3.4±0.5 vs 1.7±0.6, P<0.001).
  
  
  CONCLUSIONS
  The latest standard plates and screws used in orthopedic surgery do not pose an additional hazard or risk to patients undergoing MR imaging at 1.5-T or less. Though artifacts caused by them cannot be ignored because of their relatively large size, it is possible to be minimized by choosing appropriate pulse sequences and optimizing scanning parameters, such as FSE and STIR sequence with large bandwidth, small FOV and appropriate echo train length.
authors.affiliation: Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, China. Electronic address: zou_yf@163.com.
authors.forename: Yue-Fen
authors.initials: YF
authors.lastname: Zou
authors.affiliation: Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, China. Electronic address: 18262636700@163.com.
authors.forename: Bin
authors.initials: B
authors.lastname: Chu
authors.affiliation: Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, China. Electronic address: wangchuanb_csr@163.com.
authors.forename: Chuan-Bing
authors.initials: CB
authors.lastname: Wang
authors.affiliation: Department of Spine Surgery, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, China. Electronic address: huzhiyi@medmail.com.cn.
authors.forename: Zhi-Yi
authors.initials: ZY
authors.lastname: Hu
mesh_terms: D000368:Aged; D000497:Alloys; D000738:Androsterone / Q000031:analogs & derivatives; D016477:Artifacts; D001863:Bone Screws; D004311:Double-Blind Method; D004869:Equipment Safety; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008670:Metals; D008875:Middle Aged; D019047:Phantoms, Imaging; D019736:Prostheses and Implants; D014025:Titanium
chemical_list: D000497:Alloys; D008670:Metals; C068746:3-bromoacetoxyandrostan-17-one; D000738:Androsterone; D014025:Titanium
keywords: Artifacts; Magnetic resonance imaging; Orthopedic implant; Safety; Stainless steel; Titanium alloy