Personal use only. MRI Metal Artifact Reduction: Shoulder Implants and Arthroplasty. Reto Sutter, MD
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1 MRI Metal Artifact Reduction: Shoulder Implants and Arthroplasty Reto Sutter, MD University Hospital Balgrist Zurich University of Zurich
2 Cor PD fat sat 56-year old male patient with positive lift-off test
3 Cor PD fat sat cor STIR SEMAC
4 3 QUESTIONS
5
6 What types of artifacts? Predominant types of metal artifacts Signal loss or signal pile-up (e.g. due to spin dephasing) What types of artifacts? Displacement artifacts (due to geometric distortion) Insufficient fat suppression (fat suppression techniques are very susceptible to resonance frequency variations) Origin of distortion In-plane distortion Through-plane distortion
7 What types of artifacts? Predominant types of metal artifacts Signal loss or signal pile-up (e.g. due to spin dephasing) Displacement artifacts (due to geometric distortion) Insufficient fat suppression (fat suppression techniques are very susceptible to resonance frequency variations) Origin of distortion In-plane distortion Through-plane distortion
8 Standard TSE sequences T1 TSE T1 TSE
9 High bandwidth (tumor prosthesis) How to reduce the artifacts? T1 high BW
10 High bandwidth (tumor prosthesis) T1 high BW
11 Protocol optimization Pe rso 80 Additional Hz/Pixel Steps for Clinical 390 Use: Hz/Pixel na l Thin sections, small voxel size, small FOV 1.5T much better than 3T Fast spin echo (no gradient-echo sequence or 3D-sequence) Frequency encoding gradient parallel to long axis of prosthesis/implant us eo nly
12 Spectral Fat Saturation based on different resonance frequency of water and fat Fat saturation techniques STIR (Short Tau Inversion Recovery) based on different relaxation time of water and fat Radiofrequency Pulse Water 0 Fat Water Fat Fat Frequency 180 excitation time Sutter R., et al. Radiology 2012; 265: Blankenbaker D.G., et al. AJR 2008; 190: W1 W7.
13 STIR WARP Pe STIR highbw rso na l STIR WARP us eo nly STIR with Optimized Inversion Pulse = STIR WARP increased bandwidth of inversion RF pulse, matches increased bandwidth of excitation RF pulse robust STIR contrast around metal implants Ulbrich EJ et al. AJR 2012 Dec;199(6):W
14 Hemiprosthesis STIR WARP (optimized inversion pulse)
15 Reversed Total Shoulder Arthroplasty (RTSA) ISP STIR WARP (optimized inversion pulse)
16 Dixon technique Based on different resonance frequency of water and fat in phase opposed phase in phase Fat image opposed phase Water image Failed fat suppression Advantage : Low R.N., et al. J MRI 2011; 33: Rampton J.W., et al. AJR 2013; 201: Stable for B 0 and B 1 inhomogeneities Extensive anatomic coverage feasible 4 image contrasts in a single sequence Disadvantage : in phase Water image Residual artifacts at bone-metal interface Prolonged acquisition and image reconstruction
17 View-Angle Tilting View-angle tilting (VAT) Additional compensation gradient shifts the view-angle during readout View-angle displacement cancels in-plane displacement slice selection gradient z Signal displacement readout gradient x View angle tilting Hargreaves BA et al. AJR 2011 Sep;197(3):
18 Through-plane artifacts Only in-plane artifact reduction Standard STIR-sequence
19 Through-plane artifacts Only in-plane artifact reduction Additional through-plane artifact reduction Standard STIR-sequence STIR-SEMAC sequence Sutter R, et al. Radiology 2012; 265: Slice Encoding for Metal Artifact Correction Advanced WARP
20 Through-plane artifacts SEMAC technique for correction of through-plane distortions LU W, et al. Magn Reson Med 2009; 62:
21 Hemiprosthesis Cor STIR SEMAC
22 Hemiprosthesis SSP ISP SSC Sag PD SEMAC
23 Reversed Shoulder Arthroplasty (RTSA) STIR WARP optimized inversion pulse STIR SEMAC
24 MAVRIC (multi-acquisition variableresonance image combination) MAVRIC MAVRIC-SL Combined MAVRIC-SEMAC MAVRIC-STIR MAVRIC-SL PD PD (FSE) * * * * Pig model with screws (*) Liebl H, et al. J MRI 2015;41(5): Fritz J, et al. Radiographics 2014;34(4):E
25 MAVRIC Nwawka OK, et al. HSS J 2014;10:
26 New technology: Compressed sensing PD SEMAC CS 15 SEMAC steps, 20 iterations PD hibw
27 OVERVIEW: TECHNIQUES Increased bandwidth STIR instead of spectral fat sat Dixon View-Angle Tilting Optimized inversion pulse Through-plane correction
28 Reversed Total Shoulder Arthroplasty (RTSA) ISP insertion What is the clinical impact? Cor STIR SEMAC
29 Reversed Total Shoulder Arthroplasty (RTSA) ISP insertion Cor STIR SEMAC
30 Reversed Total Shoulder Arthroplasty (RTSA) SSC SSP ISP insertion ISP Teres min Sag PD SEMAC CS Cor STIR SEMAC
31 Reversed Total Shoulder Arthroplasty (RTSA) Pe rso SSC na l ISP Tra T1 high BW us eo Tra T1 high BW nly Teres min
32 Reversed Total Shoulder Arthroplasty (RTSA) SSC SSC Teres min Teres min Tra STIR WARP Tra T1 high BW
33 RTSA: Screw positions Pe rso Sag PD SEMAC CS na l us eo Tra T1 high BW nly
34 RTSA: Good muscle quality Pe rso Sag PD SEMAC CS na l us eo nly
35 Acromion Question: Acromion insufficiency fracture? Acromion intact
36 Latissimus dorsi + Teres major transfer Modified L Episcopo Boileau P. J Shoulder Elbow Surgery 2010;19:20. External rotation
37 Latissimus dorsi + Teres major transfer Modified L Episcopo Boileau P. J Shoulder Elbow Surgery 2010;19:20. External rotation
38 Deltoid muscle atrophy T1 high BW STIR WARP
39 Total Shoulder Arthroplasty (TSA) Cor PD MAVRIC Nwawka OK, et al. HSS J 2014;10:
40 Hemiprosthesis: Septic Loosening * * * Sag PD SEMAC CS Cor STIR SEMAC CS Tra STIR WARP
41 PHILOS Proximal Humeral Internal Locking System STIR
42 PHILOS Proximal Humeral Internal Locking System Avascular necrosis T1
43 PHILOS Proximal Humeral Internal Locking System Dixon (Water) Dixon (In Phase)
44 PHILOS Proximal Humeral Internal Locking System STIR WARP T1 high BW
45 Back to the first case Pe rso na l us eo Indication for Reversed TSA nly 56-year old male patient with positive lift-off test
46 SUMMARY: BEST TRICKS Increase bandwidth STIR instead of spectral fat sat Advanced techniques WARP, SEMAC, MAVRIC-SL
47 THANK YOU MRI Metal Artifact Reduction: Shoulder Implants and Arthroplasty Reto Sutter, MD
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