Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Neurosurg Rev. 2021 Aug;44(4):2163-2170. doi: 10.1007/s10143-020-01384-2. Epub 2020 Sep 15.
Artifacts in computed tomography (CT) and magnetic resonance imaging (MRI) due to titanium implants in spine surgery are known to cause difficulties in follow-up imaging, radiation planning, and precise dose delivery in patients with spinal tumors. Carbon fiber-reinforced polyetheretherketon (CFRP) implants aim to reduce these artifacts. Our aim was to analyze susceptibility artifacts of these implants using a standardized in vitro model. Titanium and CFRP screw-rod phantoms were embedded in 3% agarose gel. Phantoms were scanned with Siemens Somatom AS Open and 3.0-T Siemens Skyra scanners. Regions of interest (ROIs) were plotted and analyzed for CT and MRI at clinically relevant localizations. CT voxel-based imaging analysis showed a significant difference of artifact intensity and central overlay between titanium and CFRP phantoms. For the virtual regions of the spinal canal, titanium implants (ti) presented - 30.7 HU vs. 33.4 HU mean for CFRP (p < 0.001), at the posterior margin of the vertebral body 68.9 HU (ti) vs. 59.8 HU (CFRP) (p < 0.001) and at the anterior part of the vertebral body 201.2 HU (ti) vs. 70.4 HU (CFRP) (p < 0.001), respectively. MRI data was only visually interpreted due to the low sample size and lack of an objective measuring system as Hounsfield units in CT. CT imaging of the phantom with typical implant configuration for thoracic stabilization could demonstrate a significant artifact reduction in CFRP implants compared with titanium implants for evaluation of index structures. Radiolucency with less artifacts provides a better interpretation of follow-up imaging, radiation planning, and more precise dose delivery.
脊柱外科中钛植入物导致的计算机断层扫描 (CT) 和磁共振成像 (MRI) 伪影,已知会给脊柱肿瘤患者的后续成像、放射计划和精确剂量输送带来困难。碳纤维增强聚醚醚酮 (CFRP) 植入物旨在减少这些伪影。我们的目的是使用标准化的体外模型分析这些植入物的磁化率伪影。钛和 CFRP 螺钉-棒模型被嵌入 3%琼脂糖凝胶中。使用 Siemens Somatom AS Open 和 3.0-T Siemens Skyra 扫描仪对模型进行扫描。在临床相关位置绘制感兴趣区域 (ROI) 并进行 CT 和 MRI 分析。基于体素的 CT 成像分析显示,钛和 CFRP 模型之间的伪影强度和中心重叠有显著差异。对于虚拟椎管区域,钛植入物 (ti) 呈现出 -30.7 HU,而 CFRP 为 33.4 HU(p<0.001),在后缘椎体 68.9 HU(ti),而 CFRP 为 59.8 HU(p<0.001),在前缘椎体 201.2 HU(ti),而 CFRP 为 70.4 HU(p<0.001)。由于样本量小且缺乏像 CT 中的 Hounsfield 单位这样的客观测量系统,MRI 数据只能进行视觉解释。对于典型的胸段稳定植入物配置的模型 CT 成像,可以显示 CFRP 植入物与钛植入物相比,在评估索引结构时,能显著减少伪影。具有更少伪影的射线可透性可以提供更好的后续成像、放射计划和更精确的剂量输送解读。