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MRI artifacts following anterior cervical diskectomy
J L Salazar1, M Misra, D Bloom
1Department of Neurosurgery, University of Illinois at Chicago 60612, USA.
Background:
Magnetic resonance imaging (MRI), despite being an excellent imaging technique in neurosurgical practice, is unfortunately susceptible to numerous artifacts. Some of these artifacts are easily identifiable and do not interfere; however, others are more subtle and can be easily mistaken for false pathology. Postoperative MRI can further complicate the imaging interpretation, by producing another group of artifacts. It is imperative for practicing neurosurgeons, as well as neuroradiologists, to have a clear understanding of these postoperative artifacts.
Methods:
We discuss four cases who had been operated for anterior cervical decompression with bony fusion. All the patients had a postoperative MRI of the cervical region that showed a "false compression" of the cervical cord. The normal computed tomography (CT) scan in some cases and the discrepancy with the clinical condition of the patients excluded the diagnosis of compression of the cervical cord.
Results:
The overall appearance of the postoperative MRI can be very difficult to interpret. The artifact seen following anterior cervical diskectomy is an example of such a situation. We have confirmed that the postoperative MRIs showing artifacts do not indicate cord or root compression; a routine postoperative plain X ray or CT scan of the operated area can also confirm the absence of compression.
Conclusion:
These are examples of cases in which the postoperative MRI had an unexpected metallic artifact that not only caused difficulty in the interpretation of the images but at times suggested a clinical problem when actually there was none. Very thin cut CT scans may not show these artifacts that are picked up by the sensitive MRI study. A proper clinical evaluation and selection of the appropriate MRI techniques and the MRIs can eliminate or at least decrease the incidence of the artifacts. Above all, further education of practicing physicians is needed to avoid false alarms caused by these metallic artifacts.
Insights
Postoperative MRI can create metallic artifacts that mimic spinal cord compression. Routine CT scans and clinical evaluation help differentiate these artifacts from actual pathology, preventing misdiagnosis in neurosurgical patients.
Area of Science:
- Neurosurgery
- Radiology
- Medical Imaging
Background:
- Magnetic resonance imaging (MRI) is crucial in neurosurgery but prone to artifacts.
- Subtle artifacts can be mistaken for false pathology, complicating interpretation.
- Postoperative MRI introduces unique artifact challenges for clinicians.
Observation:
- Four cases of anterior cervical decompression with bony fusion presented with postoperative cervical MRI showing "false compression" of the spinal cord.
- Computed tomography (CT) scans and clinical evaluation ruled out actual cord compression.
Findings:
- Postoperative MRI artifacts, particularly after anterior cervical diskectomy, can significantly complicate image interpretation.
- These artifacts do not represent actual cord or root compression.
- Routine X-rays or CT scans can confirm the absence of compression.
Implications:
- Metallic artifacts in postoperative MRI can lead to misdiagnosis and unnecessary clinical concern.
- Thin-cut CT scans may miss these artifacts, highlighting MRI's sensitivity.
- Proper clinical evaluation, optimized MRI techniques, and physician education are essential to mitigate artifact-induced false alarms.