1213

Optimizing Imaging Parameters

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for MR Evaluation of the Spine

with Titanium Pedicle Screws

Cheryl A. Petersilge1 OBJECTIVE. This study examined the contribution and Interdependence of multiple
Jonathan S. Lewi& imaging parameters in clinical imaging sequences to aid practicing radiologists In
minimizing artifacts during MR imaging of the spine after implantation of titanium
Jeffrey L. Duerk1
pedicle screws.
Jung U. Yoo2
MATERIALS AND METHODS. A lumbar spine specimen with titanium pedicle
Alexander J. Ghaneyem3 screws implanted in the pedicle was imaged with a 1 .5-T scanner. Sequence type,
voxel volume, TE, and bandwidth varied. Different voxel volumes were achieved by
altering section thickness, field of view (FOV), and matrix size. Artifact size was mea-
sured on sagittal and axial images at the midpedlcle level. Artifact size was expressed
as a percentage of actual screw size, and mean artifact size was calculated for each
sequence. Analysis of variance without replication was done.
RESULTS. Mean artifact size ranged from 231% to 364% of actual screw size. Arti-
fact size was independent of voxel volume for voxels greater than 3 mm3 (p < .001).
Artifact size decreased significantly (p < .001) when voxel volume was less than I
mm3. When we increased slice thickness and maintained a constant voxel volume,
artifact size decreased. Decreases in artifact size correlated with a reduction in the
ratio of the FOV to the number of pixels in the frequency-encoding direction (Nx). Arti-
fact sizes were smallest when fast spin-echo sequences were used. Conventional
spin-echo sequences produced artifacts that were smaller than the artifacts produced
by the gradient-echo sequences. Decreasing the TE did not diminish artifact size for
conventional spin-echo images at larger voxel volumes.
CONCLUSION. Although voxel volume has been recognized as a factor that affects
artifact size, the role of other contributing factors-slice thickness, number of phase-
encoding steps, and FOVIN,-has not been evaluated before. Artifact reduction
proved to be dependent only on FOV/Nx. Artifact size was reduced by the use of fast
spin-echo sequences. With conventional spin-echo sequences, TE should be mini-
mized, although other technical factors may outweigh the gain in artifact reduction.

AJR 1996;166:1213-1218

MR imaging is currently the technique of choice for evaluation of the spine after
surgery. In the past, MR studies have been severely compromised in patients with
Received October 27, 1995; accepted after revi- spinal instrumentation made of stainless steel, especially low-nickel stainless
sion December 12, 1995. steel [1-5]. Today, several types of metallic implants are made of titanium. The
1 Department of Radiology, University Hospitals reason for the shift includes better biocompatibility and the physical advantages of
of Cleveland, Case Western Aeserve University,
titanium over stainless steel, including increased resistance to corrosion fatigue
11100 Euclid Ave., Cleveland, OH 44106. Address
correspondence to C. A. Petersilge. and lack of hypersensitivity response by the body [6]. Titanium also creates signif-
2Department of Orthopedics, University Hospi- icantly less distortion on MR images than does stainless steel [4, 5, 7-16].
fats of Cleveland, Case Western Reserve Universi- Improved imaging of the spine after surgery is one of the main reasons that tita-
ty, 11100 Euclid Ave., Cleveland, OH 44106.
nium rather than stainless steel pedicle screws are being used at our institution
3Department of Orthopedics, Loyola University and others in the United States.
Medical Center, 2160 South First Ave., Maywood,
IL 60153. A number of imaging factors decrease artifacts produced by metallic implants,
including shorter echo times, lower field strengths, higher readout bandwidths
0361-803X/96/1 665-1213
© American Roentgen Ray Society (Bws), and smaller voxel sizes [2, 17-22]. In previous studies, each of these
 1214 PETERSILGE ET AL. AJR:166, May 1996

parameters has been isolated from all other parameters. To rim of high signal amplitude that followed the shape of the titanium
our knowledge, the contribution by, and the interdependence screw. We measured artifact along the short axis of the screw. This
of, each of these factors in clinical imaging after hardware axis corresponded to the frequency-encoding axis in each plane.
The artifact on gradient-echo images was so severe that we did not
implantation have not been previously studied.
measure it. One author made all measurements. For all sequences,
This study was undertaken to assist practicing radiologists
artifact size for each screw was measured at the midpedicle level on
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in determining the optimal imaging parameters on a 1 .5-T

the image that contained the most welt-defined artifact. Artifact size
horizontal-bore MR imager for evaluation of the spine after was calculated and expressed as a percentage of actual screw size,
implantation of titanium hardware. using this equation:

Materials and Methods Artifact size on image (cm) 1 .

. . . . x x 100 = Anttfact size, (1)
Magnification correction factor 0.65 cm
We obtained a lumbar spine specimen that included the five lum-
bar vertebral bodies, the sacrum, and the coccyx. All paraspinal soft
tissues were stripped. The thecal sac, lower portion of the spinal
where 0.65 cm is the actual diameter of the titanium screw, and the
cord, and nerve roots remained. Using standard surgical technique, magnification correction factor is derived by measuring the width of
we placed pedicle screws that were 5.5 cm long with a 6.5-mm a 1-cm marker on the actual MR image and then dividing that mea-
outer diameter (Danek Group, Inc., Memphis, TN) bilaterally at L3, surement by 1 cm.
L4, and L5. The spine specimen was suspended in a water bath in For each sequence, the data from one screw consistently resulted
the prone position. The water bath was placed on a linearly polar- in a smatter artifact than the artifacts from the five other screws. On
ized lumbar spine coil with the spine parallel to the static magnetic review, we found this screw to be oblique to the main magnetic field,
field and imaged with a 1 .5-T Magnetom scanner (Siemens, Erlan- whereas the five other screws were all perpendicular to that field. We
gen, Germany). chose to omit data for this screw from our calculations.
We designed imaging parameters to vary 6w, TE, voxet volume, We combined the measurements from the sagittal and axial planes
and type of pulse sequence. Pulse sequences included conven- for each imaging sequence to yield 1 0 data points for each sequence.
tionat spin-echo, short-effective-echo-time fast spin-echo, and gradi-
Mean artifact size for each sequence was then calculated. We did an
ent-echo techniques. Imaging parameters for our sequences appear analysis of variance without replication using Microsoft Excel 4.0
in Table 1 . Additional parameters include an interslice gap equal to
20% of the slice thickness and two excitations. We used an echo-
train length of four in the fast spin-echo sequences. The axial and
sagittat images were obtained with the phase-encoding axis on- TABLE 1 : Imaging Parameters
ented along the length of the screw. We varied voxet volumes by
systematically altering section thickness, field of view (FOV), and TR TE Bandwidth
Sequence Type
matrix size. Parameters for our different voxel volumes are pre- (msec) (msec) (Hz/pixel)
sented in Table 2. We obtained images in the axial and sagittal
Conventional spin-echo 575 10 130
planes for all sequences. Coronal images were initially obtained, but
Conventional spin-echo 690 15 130
later omitted because the spear shape of the resulting artifact pre-
Fastspin-echo 1700 15 178
cluded its accurate measurement (Fig. 1).
Gradient-echo (3D FLASH) 20 5 260
was measured on the axial and sagittat images (Fig. 1).
Artifact
We defined the artifact as the area of signal void surrounded by a Note-3D FLASH = three-di mensionat fa st low-angle shot.

Fig. 1 -MR images after placement of titanium pedicle screws at L3, L4, and L5.
A-C, Axial (A), sagittal (B), and coronal (C) fast spin-echo MR images show significant anatomic detail despite screws. Marrow-replacing process is
clearly visible in middle vertebral body on coronal image. Arrows in A and B show artifact at midpedicle level.
 AJR:166, May 1996 MR IMAGING OF SPINE WITH TITANIUM SCREWS 1215

(Microsoft, Redmond, WA) to determine statistical significance voxel volume resulted in lower artifact for the thicker sec-
among voxel volumes of 3, 4, and 6 mm3 for each imaging sequence tions (with smaller pixel sizes), although this decrease was
and between voxel volumes of 1 and 3 mm3 for each imaging not statistically significant (p > .05).
sequence. We used the same software to determine statistical signifi- Fast spin-echo sequences produced significantly smaller
cance among imaging sequences at each voxet volume.
artifacts than conventional spin-echo sequences at all voxel
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volumes (p < .001). Artifact for the conventional spin-echo

Results sequences with the shorter TE sequence was greater than
Mean artifact size as a function of voxel volume for each with the longer TE sequence. We observed this phenomenon
sequence is plotted in Figure 2 and shown in Figure 3. Mean at all voxel volumes greater than 3 mm3. Statistical analysis
artifact size ranged from 231 % to 364% of actual screw size. revealed that mean artifact size at each voxel volume for the
For a given imaging sequence at constant section thickness, longer TE sequence was significantly different from that for
we found no statistically significant difference among voxel the shorten TE sequence, even though the corresponding
volumes of 3, 4, and 6 mm3 (p .05). These voxel volumes
> curves crossed between voxel volumes of 1 mm3 and 3 mm3.
correspond to FOVs, section thicknesses, and matrices
commonly used for MR imaging of the spine. We found a
Discussion
significant decrease in mean artifact size (p .001) between <

voxel volumes of 1 mm3 and 3 mm3 for each imaging When metallic objects are located within the imaging field,
sequence. When section thickness was 3 mm, the mean artifacts are created by differences in magnetic susceptibility
artifact size decreased from a range of 31 5% to 364% for 3- of the metal and adjacent tissues [2, 1 2, 1 7, 23]. These arti-
mm3 voxels to a range of 263% to 303% for 1 -mm3 voxels. facts vary according to the metal from which the implant is
With section thickness at 4 mm, artifact size increased from manufactured as well as its shape and orientation to the
231% for 1-mm3 voxels to 287% for 3-mm3 voxels. Thus, main magnetic field [1 , 7, 12, 1 3, 17, 18, 23, 24]. Artifacts
increasing section thickness while maintaining a constant due to magnetic susceptibility are greatest with fenromag-

Fig. 2.-Graph plotting artifact size

360
(expressed as a percentage of actual
screw size) against voxel volume for
340
each imaging sequence shows artifact
reduction only when voxel volume is 320
less than 3 mm3. --TR/TE 575110 CONVENTIONAl. SPIN ECHO

300
---6NOII5CONVEN11ONAL SPIN ECHO

ARTIFACT SIZE (%) 280 I-.-iioo’scnvn SECT)ON THICKNESS)FAST SPIN

ECHO
-6--llOQflS(4nvn SECTiON THICKJ4ESS)FAST SPIN
260 [ECHO

240

220

200
0 1 2 3 4 5 6

VOXELVOLUME(MM3)

Fig. 3.-Effect of larger voxel volume on MR Imaqing of titanjum screw in pedicle.

A-C, Axial MR images at voxel volumes of 1 mm (A), 3 mm” (B), and 6 mm3 (C) depict direct relationship between artifact size and voxel volume.
Especially note overall image degradation due to decreased resolution at larger voxel volumes.
 1216 PETERSILGE ET AL. AJR:166, May 1996

netic materials such as stainless steel. Artifact caused by tens are held constant [25-28]. Gradient-echo sequences result
titanium is markedly smaller because of the metal’s much in the most severe magnetic susceptibility artifacts because the
lower magnetic susceptibility. technique does not use refocusing pulses [2, 19].
The difference in magnetic susceptibilities of adjacent tis- Our results show a consistent relationship between voxel
sues or of tissue and implant creates local inhomogeneities volume and artifact size for each imaging sequence. Voxel
in the magnetic field. These field inhomogeneities alter the volumes of 3-6 mm3, which are currently used for imaging
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phase and frequency of the local spins. The spins are subse- the spine, create an artifact that is independent of the voxel
quently mapped to an erroneous location within the image, size for each imaging sequence. Diminution of artifact is not
creating distortions in the shape of the object along the fre- achieved until voxel volumes approach 1 mm3. This relation-
quency-encoded and slice-select axes. Loss of signal within ship between voxel volume and artifact size is explained by
the object also results [17, 1 9]. A rim of high signal intensity examining the relationship among FOV, the number of pixels
appears around the periphery of the metallic object as a in the frequency-encoding direction (Nx), and artifact size. To
result of mismapping a disproportionate number of spins to examine this relationship, we rewrote Equation 2, multiplying
that location [1 7]. Orientation of the phase- and frequency- both sides by Nx/FOV to yield:
encoding axes also affects artifact appearance [2, 7, 1 7, 19].
The spatial shift (Sx) seen on MR images is directly propor- &(BOFOV
x 2BWNx (3)
tional to the main magnetic field and inversely proportional to
the strength of the readout gradient:
where Bw = (xFOt’x and y = HzfTesIa.

x 2Gx (2) A review of our imaging parameters (Tables 1 and 2)

reveals that for voxel volumes from 3 to 6 mm3, we held con-
stant all parameters for a given sequence including FOV, Nx,
In Equation 2, x the shift of the interface (on the MR and Bw. When these parameters are constant, 5x (or image

image) between regions of different magnetic susceptibility distortion) will be constant. Voxel volumes from 3 to 6 mm3
in centimeters, LX is related to susceptibility differences, B0 were achieved by changing only the number of phase-
is the main magnetic field measured in Tesla, and Gx is the encoding steps. (The number of phase-encoding steps is not
readout gradient (Tesla/cm) [17]. a factor in Equation 3.)
Local eddy currents produced within the implant by the RF When voxel size is decreased to 1 mm3, the FOV/Nx also
pulse may also contribute to local field inhomogeneities and decreases. Thus, 5x must also decrease as described by

subsequent artifact [24]. In many imaging sequences, eddy Equation 3. We can conclude that the most important parame-
currents play a secondary role because they are very short ten in decreasing metallic artifact is not voxel volume but more
lived, decaying before the echo is acquired. specifically FOV/Nx, which describes the resolution along the
Local field distortions are reduced by shorter echo times, frequency-encoding axis. This relationship between artifact
lower field strengths, higher readout Bws, and smaller voxel vol- size and FOV/Nx is shown in Figure 4.
umes [2, 17-22]. Other imaging parameters such as TR do not A decreased FOV/Nx also explains why artifacts are
play a significant role in artifact reduction. The type of pulse smaller with thicker sections (Table 2). Because FOV, Nx, and
sequence chosen will also affect the extent of image degrada- Bw are parameters that are readily available for any MR imag-
tion by magnetic susceptibility artifact. In spin-echo imaging, ing sequence, and are routinely changed to customize
each 180 refocusing pulse compensates for dephasing. In fast sequences, one can easily use the relationship described in
spin-echo imaging, the multiple closely spaced 180* pulses pro- Equation 3 to compare expected artifact size for different
duce magnetic susceptibility artifacts that are less severe than imaging sequences. This relationship can also be used to
those in conventional spin-echo imaging, especially when short- determine the minimum resolution at which a sequence with a
effective-echo-time sequences are used and all other parame- different Bw must be run to maintain artifact size, assuming

360

340

320
-+-TR/TE 575/IOCONVENT1ONAI. SPIN ECHO

300 -a-NSPI500NVENT)ONALSPIN ECHO

ARTIFACTSIZE (%) 280 -.- I7oISi3nvn SECTIONTHICKNESS)FAST SPIN

ECHO
-#{232}-I7O5IS(4mm SECTiON THICIOESS)FA5T SPIN
260 ECHO

240
Fig. 4.-Graph plotting artIfact size
220 (expressed as a percentage of actual
screw size) against ratio of field of view
to number of pixels In frequency-en-
0.3 0.4 0.5 0.6 0.7 0.8 0.9 1 coding direction (FOVINx for each Im-
aging sequence reveals effect of
FOV/N5
resolution on artifact sIze.
 AJR:166, May 1996 MR IMAGING OF SPINE WITH TITANIUM SCREWS 1217

TABLE 2: Factors Varied to Create Different Voxel Volumes mm3. Why this unexpected relationship did not occur at 1
mm3 is also unclear. Explanation of this phenomenon awaits
No. of
Voxel Section Field of further investigation.
Phase- N a FOV/Nb
Volume Thickness View x Our results confirm a significant decrease in artifact from
(mm) (mm) Encoding
(mm3) titanium pedicle screws when fast spin-echo imaging was
Steps
compared with conventional spin-echo imaging, using clinically
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6 3 256 128 256 1.00

relevant parameters. Our fast spin-echo sequence had the
4 3 256 192 256 1.00
advantages of multiple 180’ pulses and a higher Bw. The mdi-
3 3 256 256 256 1.00
1
3
150 256 256 0.59
vidual contribution of each factor was not studied because Bw
3d is not an independently variable parameter with available soft-
300 512 512 0.59
6 4 222 128 256 0.91 ware. Our results corroborate those of Tartaglino et al. [25],
4 4 222 192 256 0.91 although they compared T2-weighted conventional spin-echo
3 4 222 256 256 0.91 images with fast spin-echo images whereas we compared Ti -

1 4 130 256 256 0.53 weighted conventional spin-echo with short-effective-echo-

4d
260 512 512 0.53 time fast spin-echo images.
aN number of pixels in frequency-encoding direction. In conclusion, magnetic susceptibility artifact from titanium
bFOv/N = ratio of field of view to number of pixels in frequency-encoding
pedicle screws was minimized by using the smallest possi-
direction. ble FOV/Nx We found that the number of phase-encoding
cSagittal plane.
plane. steps did not alter artifact size. Artifact was reduced by the
use of fast spin-echo sequences. When conventional spin-
echo sequences must be used, the smallest feasible FOV/
Nx should be chosen, and TE selected with care, because
that other imaging parameters-such as sequence type- the benefits achieved with the shortest possible TE may be
remain constant. outweighed by other technical factors.
Distortion also occurs along the slice-select axis [17] and
will be manifested in the MR image as artifact. This study
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