A comparison of magnetic and radiographic imaging artifact after using three types of metal rods: stainless steel, titanium, and vitallium

Knott, Patrick; Mardjetko, Steven; Kim, Richard H.; Cotter, Timothy; Dunn, Megan; Patel, Shivani T.; Spencer, Matthew; Wilson, Alan S.; Tager, David

doi:10.1016/j.spinee.2010.06.006

Cited by 57 publications

(42 citation statements)

References 6 publications

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“…17 While titanium systems are often preferred over stainless steel, the reduced stiffness allows more bending and deformation, which can be detrimental to spinal fusion or deformity correction, especially under high mechanical stress. 8 Cobalt-chromium alloy has the advantage of being stiffer than titanium and having a better imaging artifact profile than stainless steel. In a recent biomechanical study to evaluate the sensitivity of CoCr rods to intraoperative contouring for posterior lumbar screw-rod constructs (notch sensitivity), 3 types of constructs were assembled: 5.5-mm stainless steel rods with stainless steel screws, 6.0-mm titanium rods with titanium screws, and 6.0-mm CoCr rods with titanium screws.…”

Section: Clinical Considerations In Spinal Implant Compositionmentioning

confidence: 99%

Postoperative magnetic resonance imaging artifact with cobalt-chromium versus titanium spinal instrumentation

Ahmad¹,

Sidani

Fourzali

et al. 2013

SPI

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Object Cobalt-chromium alloy (CoCr) rods haves some preferred biomechanical properties over titanium rods for spinal fixation. The use of CoCr rods in spinal fusion is relatively new, and there is no study in the existing world literature assessing the artifact caused by these rods in patients undergoing postoperative MRI. The purpose of this study is to compare the amount of imaging artifact caused by these implants and to assess its impact on the visualization of neighboring neural structures. Methods This study investigated MR images in patients who underwent implantation of thoracolumbar instrumentation using 5.5-mm-diameter CoCr rods between November 2009 and March 2011 and images obtained in a comparison group of patients who had 5.5-mm titanium rods implanted during the same time period. Axial measurements of the artifact created by the rods between the screw heads were compared between the groups. Two blinded board-certified radiologists performed the measurements independently. They scored the visualization of the spinal canal using a subjective scoring system of 1–3, with 1 representing very good visualization and 2 and 3 representing reduced (good or suboptimal, respectively) visualization as a result of rod-related artifact. All measurements and scores were independently provided for T1-weighted and T2-weighted fast spin echo sequences (1.5-T magnet, 5-mm slice thickness). Results A total of 40 levels from the CoCr group (6 patients) and 30 levels from the titanium group (9 patients) were included in the analysis. Visualization of the canal at all levels was rated a score of 1 (very good) by both evaluators for both the CoCr and titanium groups. The average artifact on T1-weighted images measured 11.8 ± 1.8 mm for the CoCr group and 8.5 ± 1.2 mm for the titanium group (p < 0.01). The corresponding measurements on T2-weighted images were 11.0 ± 2.3 mm and 8.3 ± 1.7 mm (p < 0.01), respectively. In a mixed regression model, the mean artifact measurement for the CoCr group was, on average, 3.5 mm larger than for the control group. There was no significant difference between the measurements of the 2 evaluators (p = 0.99). Conclusions The artifact caused by CoCr rods is approximately 3.5 mm larger than that caused by titanium rods on axial T1- and T2-weighted MRI. However, artifact from either CoCr or titanium was not found to interfere with the evaluation of the spinal canal and surrounding neural elements.

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Section: Clinical Considerations In Spinal Implant Compositionmentioning

confidence: 99%

Postoperative magnetic resonance imaging artifact with cobalt-chromium versus titanium spinal instrumentation

Ahmad¹,

Sidani

Fourzali

et al. 2013

SPI

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“…2 The maximum width measured on a CT scan for a 7-mm screw is shown. purpose but has been shown to produce significant metal artifact when imaging stainless steel implants, making image interpretation difficult [2,14,17,24,26]. Since volume, or size, of implant adversely affects image quality, surgeons can choose to downsize spinal implants trading fixation strength for improved postoperative imaging capability [26,31].…”

Section: Discussionmentioning

confidence: 99%

“…Since volume, or size, of implant adversely affects image quality, surgeons can choose to downsize spinal implants trading fixation strength for improved postoperative imaging capability [26,31]. Another option is to use titanium implants, which have been shown to produce less bloom artifact [14,26,31]. However, to our knowledge, no study has addressed whether increasing size of titanium implants exhibit similar degradation of postoperative imaging.…”

Section: Discussionmentioning

confidence: 99%

“…Plain radiographs may show gross screw malposition, but advanced imaging is required to truly verify screw position in three dimensions [1]. Numerous authors have reported significant metal artifact when imaging stainless steel implants with CT or MRI making image interpretation difficult [2,14,17,24,26]. The degree of artifact produced is dependent on the cross-sectional area of the implant imaged.…”

Section: Introductionmentioning

confidence: 99%

“…Some authors have recommended using smaller implants, spaced farther apart, to improve postoperative imaging [24,31], but this may compromise fixation strength and ability to effect curve correction. Many surgeons have switched to using titanium, or titanium alloy, implants for superior postoperative imaging capability [14,25,28,31]. However, if the same volumetric effects occur with titanium alloy implants, larger implants might make assessment of screw proximity to neurovascular structures less precise.…”

Section: Introductionmentioning

confidence: 99%

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CT Provides Precise Size Assessment of Implanted Titanium Alloy Pedicle Screws

Elliott

Slakey

2014

Clinical Orthopaedics &Amp; Related Research

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Background After performing instrumented spinal fusion with pedicle screws, postoperative imaging using CT to assess screw position may be necessary. Stainless steel implants produce significant metal artifact on CT, and the degree of distortion is at least partially dependent on the cross-sectional area of the implanted device. If the same effect occurs with titanium alloy implants, ability to precisely measure proximity of screws to adjacent structures may be adversely affected as screw size increases. Questions/purposes We therefore asked whether (1) CT provides precise measurements of true screw widths; and (2) precision degrades based on the size of the titanium implant imaged.

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Bone-Implant Interface in Spine Surgery

Katonis

Alpantaki

2013

Bone-Implant Interface in Orthopedic Surgery

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A comparison of magnetic and radiographic imaging artifact after using three types of metal rods: stainless steel, titanium, and vitallium

Cited by 57 publications

References 6 publications

Postoperative magnetic resonance imaging artifact with cobalt-chromium versus titanium spinal instrumentation

Postoperative magnetic resonance imaging artifact with cobalt-chromium versus titanium spinal instrumentation

CT Provides Precise Size Assessment of Implanted Titanium Alloy Pedicle Screws

Bone-Implant Interface in Spine Surgery

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