Edmonson, Heidi A.

ABSTRACT Unexpected RF noise artifact “followed” a patient with an implanted spinal cord stimulator to multiple MR systems. Subsequent testing and clinical scanning showed no artifact, implying that the artifact originated from the implanted device. MR exams ( n = 173) performed over a two‐year period in patients ( n = 122) who had implanted spinal cord stimulators from the same manufacturer were reviewed for artifacts and device models. RF noise artifacts were observed in ~50% of exams in patients with a specific model of spinal cord stimulator, but only ~1%–8% of exams in other models from the same manufacturer. We hope that by describing this artifact, health care professionals can avoid service costs and scheduling delays.

Objective To describe the development, implementation, and validation of a radiology-administered protocol to obtain magnetic resonance imaging (MRI) in patients with cochlear implants and auditory brainstem implants without magnet removal. Study Design Retrospective review and description of novel care pathway. Methods A radiology-administered protocol was designed based on careful input from the radiology safety committee and neurotology. Radiology technologist training modules, consent instructions, patient educational material, clinical audits, and other safeguards were implemented, with samples provided in this report. The primary outcomes measured included instances of magnet displacement during MRI and premature termination of MRI studies secondary to pain. Results Between June 19, 2018, and October 12, 2021, 301 implanted ears underwent MRI without magnet removal, including 153 devices housing diametric MRI-conditional magnets, and 148 implants with conventional axial (i.e., nondiametric) magnets. Among cases with diametric MRI-conditional magnets, all studies were completed without magnet dislodgement or need to terminate imaging early due to pain. Among cases with conventional axial (nondiametric) magnets, 29 (19.6%) MRI studies were stopped prematurely secondary to pain or discomfort; the overall rate of this event was 9.6% (29 of 301) among the entire study cohort. In addition, 6.1% (9 of 148) experienced confirmed magnet displacement despite headwrap placement; the overall rate among all cases was 3.0% (9 of 301). Eight of these patients received successful external magnet reseating through manual pressure on the external scalp without surgery, and one required surgical replacement of the magnet in the operating room. There were no documented instances of hematoma, infection, device or magnet extrusion, internal device movement (i.e., gross receiver-stimulator migration), or device malfunction in this cohort related to MRI. Conclusions We present the successful implementation of a radiology-administered protocol designed to streamline care for cochlear implant and auditory brainstem implant recipients who require MRI and ease clinical demands for otolaryngology providers. Examples of resources developed, including a process map, radiology training modules, consent instructions, patient educational materials, clinical audit, and other procedural safety measures are provided so interested groups may consider adapting and implementing related measures according to need.

Purpose Diffusion‐weighted imaging allows investigators to identify structural, microstructural, and connectivity‐based differences between subjects, but variability due to session and scanner biases is a challenge. Methods To investigate DWI variability, we present MASiVar, a multisite data set consisting of 319 diffusion scans acquired at 3 T from b = 1000 to 3000 s/mm 2 across 14 healthy adults, 83 healthy children (5 to 8 years), three sites, and four scanners as a publicly available, preprocessed, and de‐identified data set. With the adult data, we demonstrate the capacity of MASiVar to simultaneously quantify the intrasession, intersession, interscanner, and intersubject variability of four common DWI processing approaches: (1) a tensor signal representation, (2) a multi‐compartment neurite orientation dispersion and density model, (3) white‐matter bundle segmentation, and (4) structural connectomics. Respectively, we evaluate region‐wise fractional anisotropy, mean diffusivity, and principal eigenvector; region‐wise CSF volume fraction, intracellular volume fraction, and orientation dispersion index; bundle‐wise shape, volume, fractional anisotropy, and length; and whole connectome correlation and maximized modularity, global efficiency, and characteristic path length. Results We plot the variability in these measures at each level and find that it consistently increases with intrasession to intersession to interscanner to intersubject effects across all processing approaches and that sometimes interscanner variability can approach intersubject variability. Conclusions This study demonstrates the potential of MASiVar to more globally investigate DWI variability across multiple levels and processing approaches simultaneously and suggests harmonization between scanners for multisite analyses should be considered before inference of group differences on subjects.

PurposeTo assess risks of RF‐heating of a vagus nerve stimulator (VNS) during 1.5 T prostate MRI using body coil transmit and to compare these risks with those associated with MRI head exams using a transmit/receive head coil.MethodsSpatial distributions of radio‐frequency (RF) B1 fields generated by transmit/receive (T/R) body and head coils were empirically assessed along the long axis of a 1.5 T MRI scanner bore. Measurements were obtained along the center axis of the scanner and laterally offset by 15 cm (body coil) and 7 cm (head coil). RF‐field measurements were supplemented with direct measurements of RF‐heating of 15 cm long copper wires affixed to and submerged in the “neck” region of the gelled saline‐filled (sodium chloride and polyacrylic acid) “head‐and‐torso” phantom. Temperature elevations at the lead tips were measured using fiber‐optic thermometers with the phantom positioned at systematically increased distances from the scanner isocenter.ResultsB1 field measurements demonstrated greater than 10 dB reduction in RF power at distances beyond 28 cm and 24 cm from isocenter for body and head coil, respectively. Moreover, RF power from body coil transmit at distances greater than 32 cm from isocenter was found to be lower than from the RF power from head coil transmit measured at locations adjacent to the coil array at its opening. Correspondingly, maximum temperature elevations at the tips of the copper wires decreased with increasing distance from isocenter — from 7.4°C at 0 cm to no appreciable heating at locations beyond 40 cm.ConclusionsFor the particular scanner model evaluated in this study, positioning an implanted VNS farther than 32 cm from isocenter (configuration achievable for prostate exams) can reduce risks of RF‐heating resulting from the body coil transmit to those associated with using a T/R head coil.