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Artifact-free coronary magnetic resonance angiography and coronary vessel wall imaging in the presence of a new, metallic, coronary magnetic resonance imaging stent.

BACKGROUND: Coronary in-stent restenosis cannot be directly assessed by magnetic resonance angiography (MRA) because of the local signal void of currently used stainless steel stents. The aim of this study was to investigate the potential of a new, dedicated, coronary MR imaging (MRI) stent for artifact-free, coronary MRA and in-stent lumen and vessel wall visualization. METHODS AND RESULTS: Fifteen prototype stents were deployed in coronary arteries of 15 healthy swine and investigated with a double-oblique, navigator-gated, free-breathing, T2-prepared, 3D cartesian gradient-echo sequence; a T2-prepared, 3D spiral gradient-echo sequence; and a T2-prepared, 3D steady-state, free-precession coronary MRA sequence. Furthermore, black-blood vessel wall imaging by a dual-inversion-recovery, turbo spin-echo sequence was performed. Artifacts of the stented vessel segment and signal intensities of the coronary vessel lumen inside and outside the stent were assessed. With all investigated sequences, the vessel lumen and wall could be visualized without artifacts, including the stented vessel segment. No signal intensity alterations inside the stent when compared with the vessel lumen outside the stent were found. CONCLUSIONS: The new, coronary MRI stent allows for completely artifact-free coronary MRA and vessel wall imaging.

Animals↗

Automatic classification of HITS into artifacts or solid or gaseous emboli by a wavelet representation combined with dual-gate TCD.

BACKGROUND AND PURPOSE: Transcranial Doppler (TCD) can detect high-intensity transient signals (HITS) in the cerebral circulation. HITS may correspond to artifacts or solid or gaseous emboli. The aim of this study was to develop an offline automated Doppler system allowing the classification of HITS. METHODS: We studied 600 HITS in vivo, including 200 artifacts from normal subjects, 200 solid emboli from patients with symptomatic internal carotid artery stenosis, and 200 gaseous emboli in stroke patients with patent foramen ovale. The study was 2-fold, each part involving 300 HITS (100 of each type). The first 300 HITS (learning set) were used to construct an automated classification algorithm. The remaining 300 HITS (validation set) were used to check the validity of this algorithm. To classify HITS, we combined dual-gate TCD with a wavelet representation and compared it with the current "gold standard," the human experts. RESULTS: A combination of the peak frequency of HITS and the time delay makes it possible to separate artifacts from emboli. On the validation set, we achieved a sensitivity of 97%, a specificity of 98%, a positive predictive value (PPV) of 99%, and a negative predictive value (NPV) of 94%. To distinguish between solid and gaseous emboli, where positive refers now to the solid emboli, we used the peak frequency, the relative power, and the envelope symmetry of HITS. On the validation set, we achieved a sensitivity of 89%, a specificity of 86%, a conditional PPV of 89%, and a conditional NPV of 89%. CONCLUSIONS: An automated wavelet representation combined with dual-gate TCD can reliably reject artifacts from emboli. From a clinical standpoint, however, this approach has only a fair accuracy in differentiating between solid and gaseous emboli.

Adult↗

Technical note: reducing motion artifacts in in vivo magnetic resonance imaging measurements of relaxation times.

Robust and accurate methods of measuring relaxation times on commercial scanners have recently been developed. Such methods overcome many machine and sequence dependent errors, but are still subject to errors arising from motion artifacts. This paper considers methods of decreasing the effect of motion artifacts in in vivo T1 and T2 measurements. Three conventional techniques for reducing such artifacts are assessed for their use with relaxation time measurement sequences. It is shown that these techniques do not adversely affect the accuracy of phantom T1 measurements made with the spin echo/inversion recovery sequence, and of T2 measurements made using the PHAPS sequence. For in vivo measurements of T1 it is also shown that these techniques reduce the standard deviation of T1 measurements in regions of interest and improve the reproducibility of such measurements overall. Two other techniques for reducing motion artifacts were found not to be compatible with the accurate measurement of relaxation times.

Adipose Tissue↗

Artifacts in spatiochromatic stimuli due to variations in preretinal absorption and axial chromatic aberration: implications for color physiology.

The spatiochromatic receptive-field structure of neurons in the macaque visual system has been studied almost exclusively with stimuli based on the human foveal cone fundamentals of Smith and Pokorny [Vision Res. 15, 161 (1975)] and generated on cathode ray tube displays. In the current study the artifacts evoked by cone-isolating, spatially structured stimuli due to variations in the eye's preretinal absorption characteristics and axial chromatic aberration are quantified. In addition, the luminance artifacts evoked by nominally isoluminant sinusoidal grating stimuli due to the same factors are quantified. The results indicate that the spatiochromatic stimuli commonly employed to map receptive fields of neurons at eccentricities > 10 deg are especially prone to artifacts and that these artifacts are maximal for the high-contrast S-cone-isolating stimuli that are often used. On the basis of these simulations, a method is introduced that improves spatiochromatic receptive-field estimates by compensating for response contributions from the incompletely silenced cone mosaics during cone-isolating stimulation.

Absorption↗

Artifacts on electroencephalograms may influence the amplitude-integrated EEG classification: a qualitative analysis in neonatal encephalopathy.

This is a case report and a descriptive study demonstrating that artifacts are common during long-term recording of amplitude-integrated electroencephalograms and may lead to erroneous classification of the amplitude-integrated electroencephalogram trace. Artifacts occurred in 12% of 200 hours of recording time sampled from a representative sample of 20 infants with neonatal encephalopathy. Artifacts derived from electrical or movement interference occurred with similar frequency; both types of artifacts influenced the voltage and width of the amplitude-integrated electroencephalogram band. This is important knowledge especially if amplitude-integrated electroencephalogram is used as a selection tool for neuroprotection intervention studies.

Artifacts↗

[Biologic artifacts in quantitative EEG].

We studied the influence of five biologic artifacts sources on quantitative EEG (blinking, forced eyes closure, forced jaw closure, tongue movements and pursuit eyes movements) through both visual and spectral analysis, with the purpose of verifying how do these artifacts can be seen in a cartographic way. We found that the spectrums potentials showed the same topographic display that was found through visual analysis. Visual analysis was superior than the quantitative evaluation to recognise the artifacts, as the former preserved the morphological display of the paroxysms. However it is important know how do the potentials are represented in quantitative maps, so that they can be identified as artifacts and not as pathologic EEG activity.

Adult↗

Magnetic resonance imaging artifact following acoustic neurofibroma surgery--case report.

Metallic artifacts in magnetic resonance (MR) imaging occur mostly in patients who have received an implant at surgery. Similar artifacts are now increasingly recognized in patients in whom high-speed drills have been used. A 15-year-old male with neurofibromatosis 2 had undergone excision of acoustic neurofibroma on the left 1.5 years prior to the present admission. MR imaging to evaluate the acoustic neurofibroma on the right showed a metallic artifact at the site of the previous surgery. Computed tomography did not show any evidence of metal debris. The artifact was probably caused by metallic dust or debris from a high-speed drill during the first surgery. We suggest that care should be taken to prevent deposition of such debris in the operative field to prevent this complication.

Adolescent↗

Optimization of CT angiography of the carotid artery with a 16-MDCT scanner: craniocaudal scan direction reduces contrast material-related perivenous artifacts.

OBJECTIVE: The objective of our study was to compare the effect of a caudocranial scan direction versus a craniocaudal scan direction on arterial enhancement and perivenous artifacts in 16-MDCT angiography of the supraaortic arteries. SUBJECTS AND METHODS: Eighty consecutive patients (51 men; mean age, 62 years; age range, 28-89 years) underwent scanning in the caudocranial direction (group 1; n = 40) or the craniocaudal direction (group 2; n = 40). All patients received 80 mL of contrast material followed by a 40-mL saline chaser bolus, both administered IV at 4 mL/sec. Bolus tracking was used. Attenuation inside the arterial lumen was measured at intervals of 1 sec throughout the data set. Attenuation in the superior vena cava (SVC) was measured. Contrast material-related perivenous artifacts were graded on a scale of 0-3 (none to extensive). RESULTS: Attenuation in the ascending aorta, carotid bifurcation, and intracranial arteries was slightly lower in group 2 versus group 1 (231 +/- 64 H, 348 +/- 52 H, and 258 +/- 48 H vs 282 +/- 43 H, 381 +/- 73 H, and 291 +/- 77 H, respectively; p < 0.05). Maximum and mean arterial attenuations were slightly lower in group 2 versus group 1 (369 +/- 58 H and 303 +/- 48 H vs 401 +/- 71 H and 334 +/- 58 H; p < 0.05). Attenuation in the SVC was much lower in group 2 versus group 1 (169 +/- 39 H vs 783 +/- 330 H; p < 0.001). Mean streak artifact score was much lower in group 2 versus group 1 (1.3 +/- 0.9 vs 2.5 +/- 0.6; p < 0.001). CONCLUSION: Use of a craniocaudal scan direction results in slightly lower attenuation of the carotid artery and much lower attenuation of the SVC. Streak artifacts are significantly reduced. This technique allows better evaluation of the ascending aorta and supraaortic arteries.

Adult↗

Truncation artifact on PET/CT: impact on measurements of activity concentration and assessment of a correction algorithm.

OBJECTIVE: Discrepancy between fields of view (FOVs) in a PET/CT scanner causes a truncation artifact when imaging extends beyond the CT FOV. The purposes of this study were to evaluate the impact of this artifact on measurements of 18F-FDG activity concentrations and to assess a truncation correction algorithm. MATERIALS AND METHODS: Two phantoms and five patients were used in this study. In the first phantom, three inserts (water, air, bone equivalent) were placed in a water-filled cylinder containing 18F-FDG. In the second phantom study, a chest phantom and a 2-L bottle fitted with a bone insert were used to simulate a patient's torso and arm. Both phantoms were imaged while positioned centrally (baseline) and at the edge of the CT FOV to induce truncation. PET images were reconstructed using attenuation maps from truncated and truncation-corrected CT images. Regions of interest (ROIs) drawn on the inserts, simulated arm, and background water of the baseline truncated and truncation-corrected PET images were compared. In addition, extremity malignancies of five patients truncated on CT images were reconstructed with and without correction and the maximum standard uptake values (SUVs) of the malignancies were compared. RESULTS: Truncation artifact manifests as a rim of high activity concentration at the edge of the truncated CT image with an adjacent low-concentration region peripherally. The correction algorithm minimizes these effects. Phantom studies showed a maximum variation of -5.4% in the truncation-corrected background water image compared with the baseline image. Activity concentration in the water insert was 6.3% higher while that of air and bone inserts was similar to baseline. Extremity malignancies showed a consistent increase in the maximum SUV after truncation correction. CONCLUSION: Truncation affects measurements of 18F-FDG activity concentrations in PET/CT. A truncation-correction algorithm corrects truncation artifacts with small residual error.

Adult↗

Low-dose high-resolution CT of the chest in children and young adults: dose, cooperation, artifact incidence, and image quality.

OBJECTIVE: The radiation dose, artifact incidence, and image quality of high-resolution chest CT examinations performed with standard and low doses and patient cooperation were investigated in children and young adults. SUBJECTS AND METHODS: Three successive controlled studies were conducted in different groups of children and young adults, totaling 203 patients. Dosimetry of high-resolution CT was performed at 180, 50, and 34 mAs in three groups of 25 patients. Streak artifact incidence using alternating 50- and 34-mAs slices was assessed and correlated with patient compliance with breath-holding commands in 44 children. Image quality was evaluated in scans obtained with 34 versus 180 mAs in cooperative patients (n = 42) and in scans obtained with 50 versus 180 mAs in noncooperative patients (n = 42). Artifacts and image quality were assessed by controlled repeated interpretations. RESULTS: Radiation dose was 5.4+/-1.6 mSv for 180 mAs, 1.5+/-0.5 mSv for 50 mAs, and 1.1+/-0.3 mSv for 34 mAs. Cooperation was obtained in 66% of the patients. Artifacts were more frequently seen in scans of noncooperative patients (30%) and in 34-mAs scans (47%); the highest incidence was found using 34 mAs in noncooperative patients (60%, p = 0.02). No differences in image quality scores were seen in scans obtained with 50 mAs versus those obtained with 180 mAs in noncooperative patients (p<0.05), and small differences were found in scans obtained with 34 mAs versus those obtained with 180 mAs in cooperative patients for fissures (p = 0.005) and peripheral structures (p = 0.02). CONCLUSION: Low-dose high-resolution CT provided a significant reduction in radiation dose (72% for 50 mAs and 80% for 34 mAs) and good-quality images of the lung when performed with 50 mAs in noncooperative and 34 mAs in cooperative pediatric and young adult patients.

Adolescent↗

Artifacts of vena cava filters ex vivo on MR angiography.

We evaluated magnetic susceptibility artifacts of nine types of vena cava filters in MR angiography (MRA) at 1.0T ex vivo in order to assess the filters' compatibility with MRA. Each filter (tulip filter, tulip MReye filter, stainless Greenfield filter, titanium Greenfield filter, TrapEase filter, Simon filter, LGM Vena-Tech filter, Antheor temporary filter, and Bird's nest filter) was inserted into an acrylic tube (20 or 25 mm in diameter, 15 or 30 cm in length). Gd-DTPA was poured into each tube at a concentration of 1/500 and each was placed in a water-filled container for imaging. We evaluated artifacts of the filters according to the following criteria: signal void beyond the tube, 3+; signal void within the tube but at more than one-half the diameter of the tube, 2+; and signal void within the tube but at less than one-half the diameter of the tube, 1+. We evaluated artifacts originating at the tip, intermediate portion, and distal end of the filters. We judged the artifacts as follows: tulip (3+, 3+, 3+); tulip MReye (2+, 1+, 1+); stainless Greenfield (2+, 1+, 2+); titanium Greenfield (1+, 1+, 1+); TrapEase (1+, 2+, 1+); Simon (2+, 2+, 1+); LGM (2+, 2+, 1+); Antheor (2+, 2+, 2+); and Bird's nest (3+, 3+, 3+). The numbers in parentheses refer to the degree of signal void at the tip, intermediate portion, and distal end of the filter, respectively. The tulip filter and Bird's nest filter made of 304 stainless steel caused extensive signal voids beyond the areas defined by the filters. The signal voids in the remaining seven filters were limited to within the tube. We concluded that seven of the nine filters were compatible with MRA ex vivo.

Artifacts↗

Artifacts in ultrasonic contrast agent studies.

Intravenously injected ultrasonic contrast agents making use of encapsulated gas microbubbles have excellent clinical potential for both color and spectral Doppler studies. However, a number of artifacts are associated with sonographic contrast agent measurements. Three artifacts were identified: (1) color "blooming," (2) increased maximum Doppler shift, and (3) spectral "bubble noise." Experiments have been conducted with Albunex and Levovist. These agents were injected into rabbits and humans to allow the cause of the artifacts to be established. Color blooming occurs soon after the bolus injection and is seen as gray scale pixels changing to color display. This is caused by the increase in flow signal strength. The apparent increase in the maximum Doppler shift frequency is due to the limited dynamic range of the spectral display. Only signals above a certain threshold are visible. As the Doppler signal power is enhanced, the highest frequency visible also increases. Finally, very large excursions can sometimes be seen in the spectral display (bubble noise). These might be due to either the breakdown of microbubbles or individual very large bubbles. The color blooming and bubble noise artifacts are easily identifiable and will not influence diagnostic management. The increase in peak Doppler shifts is more troublesome as it prevents comparison of spectral parameters obtained before and after injection of contrast agent.

Albumins↗

Effect of adaptive motion-artifact reduction on QRS detection.

Motion artifact resulting from electrode and patient movement is a significant source of noise in ECG, EEG, EMG, and impedance pneumography recording. Noise resulting from motion is particularly troublesome in ambulatory ECG recordings, such as those made during Holter monitoring or stress tests, because the bandwidth of the motion artifact overlaps with the ECG signal bandwidth. The authors investigated the effect of an adaptive motion-artifact removal algorithm on the performance of a standard QRS detector. They made four ECG recordings on each of the three subjects while manually generating artifact. Adaptive noise removal was applied to the ECG signal using a skin-stretch signal as the noise reference. Adaptive noise removal reduced the number of false QRS detections in the records from 380 to 104, for an average reduction in false detections of 72.6%. False-detection reductions for individual records ranged from 12% to 93%.

Algorithms↗

Brain SPECT artifacts in patients having metallic cranioplasty.

OBJECTIVE: Over the past few years, we have performed several brain SPECT studies on patients who have had previous head trauma that required metallic cranioplasty. Transaxial images showed clearly defined photon-deficient areas extending from the brain tissue into the area of the scalp. To investigate the extent and pattern of this type of artifact, SPECT brain phantom studies were performed and compared with the patient studies. METHODS: SPECT brain phantom studies were performed using various metallic sheets to simulate metallic plates that were used for cranioplasty. RESULTS: Phantom studies using lead to represent tantalum plates were similar to our patient studies; that is, the photon-deficient area in normal brain tissue extended into the area where normal scalp activity would be. There was also increased tracer activity at the periphery of the photon-deficient area that extended to where normal scalp activity would be. This was similar to the patient studies and was not present on the phantom studies done without any metallic sheets present. CONCLUSION: One would expect photon-deficient artifacts caused by radiopaque metallic plates in brain SPECT studies. The patient and phantom studies demonstrate that an increased tracer activity artifact is also present at the periphery of the photon-deficient area that extends into the area of the scalp. Knowing the appearance of this type of artifact caused by radiopaque metallic plates in brain SPECT studies could be beneficial, especially in cases with poor patient history and lacking radiographic correlation.

Aged↗

Disposable concentric needle electromyography electrodes artifact discharge mimicking positive sharp waves.

OBJECTIVES: To determine a new artifact discharge produced from the disposable concentric needle (DCN) electromyography (EMG) electrodes. METHODS: We have recorded the activity obtained after the first insertion of 41 DCN (37 mm) and 36 DCN (50 mm) in several muscles during the rest. The number of the patients was 77 (26 males, 51 female). RESULTS: We observed an artifact discharge (AD) resembling positive sharp waves (PSWs) in 31 patients of 77 insertions. The AD occurred with 18 of 41 insertions of DCN 37 mm and 13 of DCN 50 mm. The artifact resolved when the needle has been moved in the muscle or in the adipose subcutaneous tissue. CONCLUSION: This AD should be recognized when using DCN electrodes to avoid confusion with PSWs. Recognizing these artifacts during needle EMG is important to avoid false positive results.

Adolescent↗

Electronic off-peak status of one head of a dual-head gamma camera resulted in bone scintigraphy artifacts and faulty findings on gated myocardial SPECT.

OBJECTIVE: Gamma cameras contain energy discriminators that allow only those photons within a specified energy range to be recorded. A spontaneous shift in peak of 1 head of a dual-head gamma camera may cause artifacts. We present our experience with the incidental occurrence of off-peak status in 1 head of a dual-head gamma camera that resulted in subsequent artifacts and poor-quality images. METHODS: Four patients had been scheduled to undergo imaging on a newly installed dual-head gamma camera on the same morning. The first patient underwent (201)Tl-chloride anterior and posterior total-body imaging to check for metastatic thyroid cancer, and the images were of adequate quality for interpretation. The next 2 patients underwent dual-isotope rest (201)Tl-chloride and gated dipyridamole (99m)Tc-tetrofosmin myocardial SPECT. The rest (201)Tl myocardial SPECT images of both patients showed normal perfusion in the left ventricular wall, but the dipyridamole (99m)Tc SPECT images showed virtual absence of perfusion in the apical, anterior, and lateral walls. These findings might suggest myocardial ischemia. In addition, 1 of 2 patients' cardiac gated SPECT findings led to inaccurate left ventricular ejection fractions. Technologists did not become aware of the artifacts until the fourth patient underwent total-body bone scanning, which showed faint activity with loss of contrast in the entire anterior body. One of the camera heads was then found to have off-peak status. Thus, we abandoned use of 1 detector of the dual-head gamma camera and repeated the anterior bone scanning of the 4th patient and the dipyridamole SPECT of 1 of the 2 cardiac patients. RESULTS: Gated cardiac SPECT abnormalities resulting from off-peak status were difficult to identify and included abnor-mal left ventricular wall perfusion and an inaccurate left ventricular ejection fraction. It was determined later that the off-peak status was caused by malfunction of a photomultiplier tube. CONCLUSION: Degraded planar images resulting from the off-peak status of a camera head are easily identified. The presence of the same pattern of abnormalities in 2 consecutive myocardial SPECT examinations should alert technologists to the possibility that the abnormalities are, in fact, artifacts.

Artifacts↗

Gated (99m)Tc-tetrofosmin SPECT for discriminating infarct from artifact in fixed myocardial perfusion defects.

UNLABELLED: Soft-tissue attenuation artifacts generally appear as fixed perfusion-scan defects. Gated (99m)Tc-tetrofosmin SPECT may help differentiate myocardial infarction (MI) from artifacts, as fixed defects with decreased function (wall motion and thickening) probably represent MI, whereas attenuation artifacts represent preserved function. METHODS: Ungated stress and gated rest (99m)Tc-tetrofosmin SPECT was performed on 153 consecutive patients referred for evaluation of coronary artery disease. From stress and summed gated rest images, 107 patients (70%) were identified with isolated fixed defects. The function of the defects was assessed semiquantitatively from gated stress images. The findings were correlated with clinical (history or electrocardiographic Q waves) evidence of MI. RESULTS: Of 62 patients with fixed defects and clinical MI, 60 (97%) had an abnormal defect function. Of 45 patients with no clinical MI, 16 (36%) had decreased function of the defect, possibly indicating silent MI. In 29 of the 45 patients (64%) with no clinical MI, defect function was normal. Because most (90%) fixed defects with normal systolic function occurred in men with inferior fixed defects (87%) or women with anterior fixed defects (3%), these were most likely attenuation artifacts. By reclassifying the condition of patients with fixed defects and normal function as normal, patients with unexplained fixed defects (no clinical MI) decreased from 29% to 10%. CONCLUSION: Gating adds considerable value to (99m)Tc-tetrofosmin SPECT myocardial perfusion imaging in characterizing fixed defects and potentially improves test specificity.

Adenosine↗

[Intracranial artifact un magnetic resonance caused by embolization of microscopic metallic fragment].

Magnetic resonance imaging (MRI) artifacts have been described in many articles published in the literature. We present the case of a 72 year old man who was admitted due to left inferior limb weakness. MRI imaging demonstrated an acute right infarction of the right posterior cerebral artery. In the right frontal lobe a metallic artifact was demonstrated as well. The artifact showed a central signal void and it was surrounded by a high signal intensity rim. His aortic valve had been replaced 12 years earlier. This indicates that the artifact is in fact due to a small metallic fragment embolization during cardiac surgery.

Aged↗