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The interobserver-validated relevance of intervertebral spacer materials in MRI artifacting.

Intervertebral spacers for anterior spine fusion are made of different materials, such as titanium, carbon or cobalt-chrome, which can affect the post-fusion MRI scans. Implant-related susceptibility artifacts can decrease the quality of MRI scans, thwarting proper evaluation. This cadaver study aimed to demonstrate the extent that implant-related MRI artifacting affects the post-fusion evaluation of intervertebral spacers. In a cadaveric porcine spine, we evaluated the post-implantation MRI scans of three intervertebral spacers that differed in shape, material, surface qualities and implantation technique. A spacer made of human cortical bone was used as a control. The median sagittal MRI slice was divided into 12 regions of interest (ROI). No significant differences were found on 15 different MRI sequences read independently by an interobserver-validated team of specialists (P>0.05). Artifact-affected image quality was rated on a score of 0-1-2. A maximum score of 24 points (100%) was possible. Turbo spin echo sequences produced the best scores for all spacers and the control. Only the control achieved a score of 100%. The carbon, titanium and cobalt-chrome spacers scored 83.3, 62.5 and 50%, respectively. Our scoring system allowed us to create an implant-related ranking of MRI scan quality in reference to the control that was independent of artifact dimensions. The carbon spacer had the lowest percentage of susceptibility artifacts. Even with turbo spin echo sequences, the susceptibility artifacts produced by the metallic spacers showed a high degree of variability. Despite optimum sequencing, implant design and material are relevant factors in MRI artifacting.

Animals↗

Reduction of computed tomography metal artifacts due to the Fletcher-Suit applicator in gynecology patients receiving intracavitary brachytherapy.

PURPOSE: To evaluate a method of reducing computed tomography (CT) metal artifacts due to the Fletcher-Suit applicator. METHODS AND MATERIALS: We apply a projection-interpolation algorithm to CT images containing artifacts from the brachytherapy applicator. Regions of projection data containing the applicator are interpolated, removing the metal from the projections. A new image is then reconstructed, and a pixel-by-pixel correction factor applied to the original image to reduce the severity of metal artifacts. This technique is applied to phantom and patient image data. RESULTS: Qualitative and quantitative comparisons of images produced before and after projection-interpolation show a significant reduction in metal artifacts. In patient images containing the tandem alone, this method almost completely eliminated the artifact. In slices containing both tandem and colpostats, the algorithm reduced artifacts but did not completely eliminate them. CONCLUSIONS: The projection-interpolation method can be used to reduce the severity of metal artifacts caused by the Fletcher-Suit applicator.

Algorithms↗

Determinants of aortic artifacts during transesophageal echocardiography of the ascending aorta.

BACKGROUND: The origin of artifacts of the ascending aorta during transesophageal echocardiography has not been widely studied. This study was undertaken to investigate in vivo whether anatomic features could determine the appearance of artifacts. METHODS AND RESULTS: Transesophageal echocardiograms of 46 patients studied for suspected dissection with proven diagnosis (30 patients with and 16 without ascending aortic dissection) were reviewed. The incidence of artifacts was 46%, and it was similar in patients with and those without dissection (chi-square 0.516; P = not significant). Artifacts were located in the aortic lumen twice as far from the transducer as the atrial-aortic interface. The aortic diameter was larger in patients with than in those without artifacts (6.4 +/- 1.1 vs 4.2 +/- 0.9 cm, P <.001). An aortic diameter >5 cm and an atrial-aortic ratio </=0.6 predicted the artifact appearance with good sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy; these parameters reached a value of 100% by analysis only of patients without dissection. CONCLUSIONS: An ascending aortic diameter >5.0 cm that exceeds the left atrial diameter with an atrial-aortic ratio </=0.6 creates in vivo the conditions for the reverberation of the atrial-aortic interface within the aorta. Therefore, in patients with such anatomic features, artifacts must be suspected in the presence of linear structures within the aorta.

Aortic Dissection↗

A digital averaging method for removal of stimulus artifacts in neurophysiologic experiments.

Stimulation artifacts can greatly complicate the evaluation of short-latency responses in experiments in which anterograde stimulation techniques are used to investigate connections between different brain regions. For an experiment involving recording of the responses in the primate substantia nigra pars reticulata to stimulation at various sites in the striatum, a digital averaging technique was developed for removing stimulation artifacts from traces of neuronal signals. In the first of two stages of this procedure, an estimate of the average stimulus artifact is calculated from traces of multiple stimulations at the same site. In the second step, the resulting average stimulation artifact (after time- and amplitude-optimization) is subtracted from individual data segments that contain the artifact. The data presented here demonstrate that this technique, applied off-line, is highly effective in removing artifacts, and uncovering neuronal potentials superimposed on the artifact. Faster computers and optimized software may make on-line application of this technique feasible.

Animals↗

Quantification and rejection of ocular artifacts in auditory evoked fields in schizophrenics.

RESULTS: In a magnetoencephalographic investigation of the auditory evoked field (AEF) in 17 schizophrenics and 17 controls, 37% of the schizophrenics and 12% of the controls showed eye artifacts in every second trial or even more frequently. In the uncorrected average fields, the ratio between the power of artifacts and the power of the magnetoencephalogram (MEG) exceeded the value of 0.1 for 48% of the schizophrenics and for 29% of the controls. Ocular artifacts biased the locations of equivalent current dipoles of the M100 component towards deeper positions. A regression algorithm for the correction of ocular artifacts in raw data and an identification technique of ocular artifacts based on the topography of transmission coefficients is described. CONCLUSIONS: A linear dependence of ocular artifacts in AEF on the electrooculogram (EOG) was confirmed. Possible errors introduced by the correction are discussed. Transmission coefficients should be calculated for several individual trials with the same type of artifact. Errors due to evoked potentials in the EOG were found to be comparable in amplitude to noise in the AEF. Examples of transmission coefficients from the EOG to the MEG are given.

Adult↗

The effects of ocular artifacts on (lateralized) broadband power in the EEG.

OBJECTIVE: Empirical evidence suggests that blinks and eye movements do not generate substantial activity outside the delta and theta range, and that the propagation of ocular activity to the EEG is rather symmetrical. These observations suggest that an alteration of the alpha and beta asymmetry of the EEG due to ocular artifacts is not likely to occur. The aim of the present study is to examine the effects of ocular artifacts on broadband EEG parameters. METHODS: EEG and EOG were recorded from 31 participants in a resting condition with eyes open and closed, allowing for spontaneous ocular activity. General effects of ocular artifacts were examined with mean comparisons, and differential effects were examined with correlation analysis of data portions that were selected for a presence or absence of artifacts. RESULTS: At single sites, blinks and eye movements exerted substantial general effects on the whole EEG spectrum, but there were no substantial differential effects of artifacts in the alpha and beta bands, except at the frontopolar sites. The distorting effects of ocular artifacts were smaller in magnitude for asymmetry than for single site measures. CONCLUSIONS: The control of ocular artifacts may be dispensable for correlation analyses of alpha or beta band parameters.

Adult↗

Capillary electrophoresis artifact due to eosin: implications for the interpretation of molecular diagnostic assays.

Capillary electrophoresis (CE) is a commonly used tool in the analysis of fluorescently labeled PCR amplification products. We have identified a CE artifact caused by the tissue stain eosin that can complicate the interpretation of CE data. The artifact was detected during routine analysis of a DNA sample isolated from a formalin-fixed, paraffin-embedded tissue sample considered histologically suspicious for a B-cell neoplasm. A standard clinical PCR and CE assay for immunoglobulin heavy chain (IGH) gene rearrangement revealed a weak polyclonal population of rearranged IGH genes and a 71 base peak suspicious for IGH clonality. The spectral properties of the 71 base peak were unusual in that although the dominant fluorescence of the peak was blue, it also fluoresced in green and yellow (blue>green>yellow), raising the suspicion that the peak might represent an artifact. CE analysis of the genomic DNA sample without PCR amplification demonstrated the presence of the 71 base peak, suggesting that the artifact was caused by a contaminant within the DNA sample itself. We demonstrate that eosin, which was used to stain the formalin-fixed tissue during processing, yields a discrete 71 base peak of similar morphology to the contaminant peak on CE analysis. The data suggest that eosin in the fixed tissue was not completely eliminated during nucleic acid extraction, resulting in the artifact peak. We discuss the implications of this potentially common contaminant on the interpretation of CE data and demonstrate that artifacts caused by eosin can be avoided by using more stringent DNA purification steps. Histological dyes may fluoresce, and artifacts from them should be considered when primary peaks contain additional underlying peaks of other colors.

Aged↗

Contributions of an adiabatic initial inversion pulse and K-space re-ordered by inversion-time at each slice position (KRISP) to control of CSF artifacts and visualization of the brain in FLAIR magnetic resonance imaging.

AIM: The aim of this study was to compare the performance of three fluid attenuated inversion recovery (FLAIR) pulse sequences for control of cerebrospinal fluid (CSF) and blood flow artifacts in imaging of the brain. The first of these sequences had an initial sinc inversion pulse which was followed by conventional k-space mapping. The second had an initial sinc inversion pulse followed by k-space re-ordered by inversion time at each slice position (KRISP) and the third had an adiabatic initial inversion pulse followed by KRISP. MATERIALS AND METHODS: Ten patients with established disease were studied with all three pulse sequences. Seven were also studied with the adiabatic KRISP sequence after contrast enhancement. Their images were evaluated for patient motion artifact, CSF and blood flow artifact as well as conspicuity of the cortex, meninges, ventricular system, brainstem and cerebellum. The conspicuity of lesions and the degree of enhancement were also evaluated. RESULTS: Both the sinc and adiabatic KRISP FLAIR sequences showed better control of CSF and blood flow artifacts than the conventional FLAIR sequence. In addition the adiabatic KRISP FLAIR sequence showed better control of CSF artifact at the inferior aspect of the posterior fossa. The lesion conspicuity was similar for each of the FLAIR sequences as was the degree of contrast enhancement to that shown with a T(1)weighted spin echo sequence. CONCLUSION: The KRISP FLAIR sequence controls high signal artifacts from CSF flow and blood flow and the adiabatic pulse controls high signal artifacts due to inadequate inversion of the CSF magnetization at the periphery of the head transmitter coil. The KRISP FLAIR sequence also improves cortical and meningeal definition as a result of an edge enhancement effect. The effects are synergistic and can be usefully combined in a single pulse sequence. Curati, W. L.et al. (2001)Clinical Radiology56, 375-384

Adult↗

[Artifacts in MR imaging of the temporomandibular joint caused by dental alloys: a phantom model study at T1.5].

PURPOSE: The influence of dental alloys on MRI of the temporomandibular joint was studied using a phantom model for this joint. METHODS: At 1,5 T, 15 dental alloys and 14 of their most important components were investigated acquiring sagittal (FOV: 150 mm) and transverse (FOV: 250 mm) T1-weighted SE images. In 11 cases, T1- and T2*-weighted FLASH images were measured additionally. The artifacts were assessed qualitatively as well as quantitatively, and the samples were subdivided into four artifact categories. RESULTS: Ag, Cu, Ga, In, Tl, Sn, Zn, amalgam, the precious alloys, the Au-Pd and Ag-Pd alloys showed no artifacts (category I). Minimal artifacts below 10 mm on transverse images (category II) were found for Cr, Pd, Pt and for the Ni-Cr alloy. Mn and the remaining non-precious alloys induced artifacts up to 30 mm (category III). Significant artifacts-more than 30 mm-(category IV) were caused by Ni-Cr and 18/8 wires and by Co, Fe, and Ni. T2*-weighted FLASH proved to be more susceptible for artifacts than T1-weighted SE and FLASH techniques. CONCLUSIONS: In contrast to dental alloys for fixed prosthodontics, Ni-Cr- or 18/8 wires used for orthodontic bands can influence not only the image quality, but also the diagnostic reliability of MRI of the temporomandibular joint.

Artifacts↗

Common electrocardiographic artifacts mimicking arrhythmias in ambulatory monitoring.

BACKGROUND: Ambulatory electrocardiographic monitoring is used in clinical practice as a means of detecting cardiac arrhythmias during daily activities. Current equipment provides analysis for the detection of arrhythmias, ST-segment deviation, and more sophisticated analyses (late potentials, Q-T behavior, and heart-rate variability). However, despite the system used, a number of artifacts could mislead diagnosis. METHODS AND RESULTS: We prospectively searched for artifacts during ambulatory electrocardiography in patients referred for monitoring to our institution, a tertiary referral center. Patients were ambulatory at home, work, school, or within the hospital. We divided artifacts according to Krasnow and Bloomfield's classification (pseudoarrhythmia, nonarrhythmia), and we added a new category, artifacts in patients with pacemakers. Artifacts encountered mimicked sinus arrest, supraventricular arrhythmias, ventricular arrhythmias, and aberrancy. Examples of each one and diagnostic clues are provided to recognize these artifacts properly. CONCLUSIONS: A substantial amount of invalid data (false-positive findings because of electrocardiographic artifacts) were identified during ambulatory electrocardiographic monitoring that can lead to inappropriate interpretation and may result in severe diagnostic errors.

Arrhythmias, Cardiac↗

Application of pixel truncation to reduce intensity artifacts in myocardial SPECT imaging with Tc-99m tetrofosmin.

BACKGROUND: Technetium 99m-labeled radiopharmaceuticals accumulate in the liver and gallbladder, where they generate intensity artifacts that can result in misdiagnosis of myocardial single photon emission computed tomography (SPECT) images. This study identifies and eliminates factors affecting the magnitude and appearance of intensity artifacts in a gallbladder-heart phantom. METHODS AND RESULTS: The myocardium and background compartments of a phantom were filled with Tc-99m at concentrations of 320 and 26.1 kBq/mL, respectively. A disposable plastic syringe containing 5 mL of Tc-99m as a model of the gallbladder was fixed in a position lateral to the heart phantom. Artifact intensity was determined on SPECT images over a specific activity range in the syringe (28.6, 6.6, and 0.2 MBq/mL). Among 72 projection images, those with maximal heart counts in the region of interest were selected. Counts above and below 110% of the maximal heart count in all projection images were excluded and reconstructed, respectively. At 28.6 and 6.6 MBq/mL, excessive artifacts generated cold pixels immediately around the source, whereas lower activity (0.2 MBq/mL) caused the artifacts to disappear. Truncating the counts in the gallbladder caused the intensity artifacts at specific activities of 28.6 and 6.6 MBq/mL to disappear. CONCLUSIONS: The magnitude and appearance of intensity artifacts depend on contrast between extracardiac activities in the same slices of the heart in myocardial SPECT images with Tc-99m tetrofosmin, and pixel truncation can eliminate them.

Artifacts↗

Motion artifacts of the aorta simulating aortic dissection on spiral CT.

PURPOSE: Motion artifacts of the ascending aorta may impair image quality and simulate an intimal flap or a false channel. The purpose of this study is to evaluate the prevalence, amplitude, and extent of motion artifacts of the aorta in spiral CT and to specify the effects of acquisition and reconstruction parameters on these artifacts. METHOD: One hundred seventy-one thoracic spiral CT examinations were retrospectively analyzed by two reviewers. The analysis sought to determine the presence, location, amplitude, and extent of artifacts of the ascending aorta. RESULTS: Aortic artifacts were detected on spiral CT in 57% of cases. The mean amplitude and mean extent were 4+/-4 and 6+/-7 mm, respectively. Artifacts in the ascending aorta were significantly higher with the 360 degrees linear interpolation (LI) algorithm than with the 180 degrees LI algorithm. CONCLUSION: The prevalence of motion artifacts on spiral CT is higher in this study than the reported prevalence in incremental CT. However, this higher prevalence is significantly reduced when the 180 degrees LI algorithm is used.

Aortic Dissection↗

Iatrogenic artifacts on whole-body F-18 FDG PET imaging.

PURPOSE: Whole-body F-18 FDG PET images frequently show artifacts related to medical and surgical interventions. We present some of the common artifact patterns in this atlas article. MATERIALS AND METHODS: We studied whole-body F-18 FDG PET images of 30 adult patients (17 males and 13 females). Of these, 9 patients had lymphoma, 7 had colon cancer, 6 had lung cancer, 3 had lung nodules, 2 each had breast and bladder cancer, and 1 patient had brain cancer. All patients had a history of some surgical or medical intervention for malignant or some other associated disease. RESULTS: PET images of 8 patients showed artifacts related to implanted prostheses and ports and 9 patients showed artifacts related to percutaneous insertion or opening of catheters, tubes, and stomas. Six patients had artifacts from previous surgery, 3 from previous radiation therapy, 3 from previous chemotherapy, and 1 from changes in glucose metabolism. CONCLUSIONS: Medical and surgical interventions can give rise to artifacts on whole-body F-18 FDG PET images. The possibilities and patterns of these artifacts should be kept in mind while reporting these studies.

Adult↗

Automated detection and elimination of periodic ECG artifacts in EEG using the energy interval histogram method.

An automated method for electrocardiogram (ECG)-artifact detection and elimination is proposed for application to a single-channel electroencephalogram (EEG) without a separate ECG channel for reference. The method is based on three characteristics of ECG artifacts: the spike-like property, the periodicity and the lack of correlation with the EEG. The method involves a two-step process: ECG artifact detection using the energy interval histogram (EIH) method and ECG artifact elimination using a modification of ensemble average subtraction. We applied a smoothed nonlinear energy operator to the contaminated EEG, which significantly emphasized the ECG artifacts compared with the background EEG. The EIH method was initially proposed to estimate the rate of false positives (FPs) and false negatives (FNs) that were necessary to determine the optimal threshold for the detection of the ECG artifact. As a postprocessing step, we used two types of threshold adjusting algorithms that were based on the periodicity of the ECG R-peaks. The technique was applied to four whole-night sleep EEG recordings from four subjects with severe obstructive sleep apnea syndrome, from which a total of 132878 heartbeats were monitored over 31.8 h. We found that ECG artifacts were successfully detected and eliminated with FP = 0.017 and FN = 0.074 for the epochs where the elimination process is necessarily required.

Algorithms↗

Independent component analysis removing artifacts in ictal recordings.

PURPOSE: Independent component analysis (ICA) is a novel algorithm able to separate independent components from complex signals. Studies in interictal EEG demonstrate its usefulness to eliminate eye, muscle, 50-Hz, electrocardiogram (ECG), and electrode artifacts. The goal of this study was to evaluate the usefulness of ICA in removing artifacts in ictal recordings with a known EEG onset. METHODS: We studied 20 seizures of nine patients with focal epilepsy monitored in our video-EEG monitoring unit. ICA was applied to remove obvious artifacts in segments at the beginning of the seizure. The final EEGs were exported to the original format and were compared with the original EEG by two blinded examiners. We compared original recordings and the samples cleaned by digital filters (DFs), ICA and ICA plus digital filters (ICA + DFs), evaluating the possibility of finding an ictal pattern, the localization of the onset in area and time, and the global quality of the sample. RESULTS: All the recordings except one (95%) improved after the use of ICA for the elimination of blinking and other artifacts. Three seizures were found in which in the original recordings did not permit us to detect an ictal pattern, and after ICA + DFs, an ictal onset was evident; in two of them, ICA alone was able to show this pattern. The best results in all the scores were obtained with ICA + DF. ICA was better than DFs. The agreement between the two reviewers was highly significant. CONCLUSIONS: ICA is useful to remove artifacts from ictal recordings. When applied to ictal recordings, it increases the quality of the recording. In some cases, ICA may be useful to show ictal onsets obscured by artifacts. ICA + DFs obtained the best results regarding removal of the artifacts.

Adult↗

A new algorithm for minimizing pacemaker polarization artifact: universally applicable in permanent pacing systems.

Polarization artifacts that result from pacing may interfere with analysis of paced evoked responses during, e.g., automatic threshold tracking. We have developed a method for reduction of such artifacts that relies on the introduction of pacing stimuli during the refractory period of unipolar or bipolar paced captured beats after previous identification of a refractory period "template" or baseline. The refractory pacing stimuli cannot capture the heart, and thus any deviation from the template is due to polarization artifact alone. The artifact amplitude is measured and the precharge duration of the triphasic stimulus waveform is changed each time until artifact is minimized, as detected by repeated reversals in the polarity of the polarization artifact. In a series of 11 patients with unipolar and bipolar permanent pacing leads, mean initial artifact before balancing was 1.44 +/- 0.84 mV, which was reduced to 0.44 +/- 0.30 mV after balancing (P = 0.001). Initial precharge duration was 3.2 msec by design; mean final precharge duration was 3.30 +/- 0.34 msec. This algorithm is universally applicable in permanent pacing systems, as it is valid in unipolar and bipolar pacing and it does not require an intrinsic cardiac rhythm.

Algorithms↗

Minimum scan speeds for suppression of motion artifacts in CT.

Cardiac and ventilatory motions cause artifacts at chest computed tomography (CT). To determine how short the scan times on third-generation units must be to avoid such artifacts, motion was measured with fast and ultrafast CT scans. Minimum detectable motion was then determined. The longest scan time that avoided a barely perceptible artifact was calculated by dividing the minimum detectable motion by the peak physiologic velocity. The posterior left ventricular wall moved at a maximum velocity of 52.5 mm/sec, necessitating a scan time of 19.1 msec or less to avoid artifact. Lung vessels near the heart moved at 40.5 mm/sec for a scan time of 24.7 msec or less. During quiet breathing, pulmonary vessels moved at 10.7 mm/sec for a scan time of 93.5 msec or less. The authors conclude that the shortest scan time on third-generation units (0.6 second) cannot prevent all artifacts arising from motion in the chest. Even ultrafast scan times (50 msec) are not short enough to eliminate artifacts on these units. Thus, reduction of motion artifacts will require techniques other than fast scanning.

Artifacts↗

Coronary arterial stents: safety and artifacts during MR imaging.

PURPOSE: To investigate the safety and imaging artifacts with different coronary arterial stents and magnetic resonance (MR) imaging sequences. MATERIALS AND METHODS: The heating, artifacts, and ferromagnetism with different stents were studied with a 1.5-T MR tomograph with ultrafast gradients by using turbo spin-echo, turbo gradient-echo, and echo-planar imaging sequences. Nineteen stents, which were 8-25 mm in length and 3.0-4.5 mm in diameter, were evaluated. Stent deviation induced by the magnetic field and during MR imaging, migration, and heating caused by the radio-frequency pulses were examined. The size of imaging artifacts was measured with all the stents under standardized conditions and with six stents after their implantation into the coronary arteries of freshly explanted pig hearts. RESULTS: All except two types of stents showed minimal ferromagnetism. No device migration or heating was induced. Turbo spin-echo images had minimal artifacts; larger artifacts were seen on the turbo gradient-echo and echo-planar images. With ultrafast gradients, the artifacts on the echo-planar images were substantially reduced. CONCLUSION: The studied coronary stents were not influenced by heating or motion during 1.5-T MR imaging. Artifact size differed according to the type and size of the stent and the MR imaging sequence used. Thus, patients with these stents can be safely examined.

Angioplasty, Balloon, Coronary↗