Methods for the Quantitative Assessment of Image Artifacts Caused by Implantable Devices

B. A. Coppola1, R. E. Shehada1, P. N. Costandi1, K. Jurkowski1, and A. Dianaty1

1
Cardiac Rhythm Management Division, St Jude Medical, Sylmar, CA, United States

Introduction: The presence of a metallic implant in the field of view of an MRI image creates a magnetic susceptibility artifact, which may
complicate the interpretation of the underlying anatomical image and in some cases result in false diagnoses. The void in the image that is left by the
metallic implant may extend beyond the dimensions of the implant itself. Furthermore, geometric distortion may occur beyond this void. ASTM
standard F2119–07 defines a pixel as being part of an artifact if its intensity value is changed by at least 30% relative to a reference image. The
artifact size is then quantified by a manual measurement of the dimensions of this 30% region. The clinical utility of this standard is limited. First, it
ignores subtle distortions to the image which are not reflected as a 30% change in pixel intensity. Second, it involves manual measurements of the
30% zone which may not be clearly defined, leading to results that are subjective and not readily automated. Therefore, the objective of this work
was to develop an image artifact quantification method that resolves these shortcomings. First, we developed a grid system to identify distortion of
the image extending beyond the void created by the metallic implant. Second, we created a new method to automatically quantify image artifacts
using image correlation. Combination of these methods may result in a more meaningful visualization for clinicians.
Methods: Image artifacts were assessed by comparing a pair of images, one serving as a reference and the other
including the metallic implant. We developed a three-dimensional grid phantom with 2.54 cm grid spacing to
serve as the reference image as shown in Figure 1. The grid phantom allows the evaluation of image artifacts on
the interpretability of structures surrounding the device. The structure includes a central gap that houses a
pedestal for securing the implant in place. The phantom was filled with a CuS04-5H20 mixture. A pacemaker
was imaged with 2 different pulse sequences, using all possible phase encoding/readout combinations for each of
three orthogonal imaging planes. Seven 5mm slices through the implant were acquired in each configuration to
ensure capture of the largest artifact. The field of view was 40x40 cm with a data matrix of 256x256 pixels.
Following image acquisition, data processing was performed on each image pair (reference only, implant) as
follows. A window size of 25x25 pixels was defined, which is large enough to capture the features of the
reference grid but small enough to sufficiently discretize the image. A correlation coefficient was computed for
all 53361 possible 25x25 pixel windows in each image pair. Because the windows overlap, most pixels in the
image are part of multiple windows (as many as 625). The correlation coefficient assigned to a single pixel was
the average value of all windows in which that pixel resides. Thus a unique correlation coefficient was defined
at every pixel within the image. Generally speaking, in regions far from the implant the correlation will be high,
and in regions around the implant the correlation will be low. Correlation coefficients between 0.7 and 1.0
indicate a strong positive linear relationship via a firm linear rule and therefore pixels with correlation coefficient
of less than 0.7 were considered to be part of an image artifact.
Results: The correlation method was applied to MR images of a pacemaker. An isoline representing the Figure 1. Reference grid on
correlation threshold of 0.7 was superimposed on the implant image. This isoline bounds the region of low the imaging table. Bottom:
correlation associated with the image artifact. A sample result is shown in the figure below. The pacemaker was Close up of implant
oriented with its face parallel to the coronal plane, using a gradient echo sequence with phase encoding from (pacemaker) fixed within
right to left and readout from head to foot. reference grid.

Figure 2. From left to right: Reference image; Implant image; Region with correlation coefficient < 0.7 outlined in white; ASTM method with
maximum dimension annotated (change in pixel intensity > 30% shown in black).

Discussion: As seen in Figure 2, this technique is capable of identifying distortions to the reference grid that extend beyond the void introduced by
the metallic implant. The degree of allowable distortion is controlled by the threshold value of the correlation coefficient. In comparison, the ASTM
method also reveals some of the distortion surrounding the void. However, the standard states that one should measure “to the fringe of the artifact
[±30% zone],” which can have multiple interpretations. One interpretation of the maximum artifact dimension is shown in Figure 2. In conclusion,
we have developed an automated method of image artifact quantification which provides an objective result and a clinically meaningful visualization.

Proc. Intl. Soc. Mag. Reson. Med. 19 (2011) 1791