Magnetic Resonance Imaging Artifacts in Adjustable differential pressure valves

Magnetic resonance imaging artifacts of adjustable shunt devices are thought to be similar to metal clip artifacts, in that they are larger with higher field strength scanners. Amano et al. published several reports about the artifacts of new MRI-resistant adjustable shunt devices, and found a case in which a 3.0-T scanner showed smaller artifacts than the 1.5-T scanner. They aimed to clarify whether this claim is true or not.

Under permission of the institutional Ethical Committee, 2 volunteers underwent imaging studies using 3T MRI Scanner and 1.5-T scanners from GE, Siemens, and Philips. Four MRI-resistant adjustable shunt devices-proGAV2.0 (Miethke), Codman Certas Plus (Johnson & Johnson), Polaris (Sophysa), and Strata MR valve (Medtronic)-were fixed on the left temporal scalp. Routine MRI images, including T1-and T2-weighted imaging, fluid-attenuated inversion recovery, diffusion-weighted imaging (DWI), and magnetic resonance angiography (MRA), were obtained. We also compared artifacts between a 3.0-T scanner and a-1.5 T scanner in 4 patients.

The 3.0 T-scanners showed smaller artifacts than the 1.5-T scanners on DWI and MRA images for all shunt devices and scanners. In the other sequences, the results depended on the MRI scanner manufacturer; however, the GE 3.0-T scanner showed smaller artifacts in every sequence. This was also true in the 4 clinical cases.

A 3.0-T scanner is recommended over a 1.5-T scanner for patients with MRI-resistant adjustable shunt devices in the diagnosis of acute ischemic condition or when using GE scanners 1)

Adjustable shunt valves that have been developed for the management of hydrocephalus all rely on intrinsically magnetic components, and artifacts with these valves on MRI are thus inevitable. The authors have previously reported that the shapes of shunt artifacts differ under different valve pressures with the proGAV 2.0 valve. In the present study the authors compared the size and shape of artifacts at different pressure settings with 4 new-model shunt valves.METHODSThe authors attached 4 new models of MRI-resistant shunt valve to the temporal scalp of a healthy volunteer: the proGAV 2.0; Codman Certas Plus; Polaris; and Strata MR. They set 3 different scales of pressures for each valve, depending on magnet orientation to the body axis. Artifacts were evaluated and compared among all valves on a 3.0-T GE scanner and 2 valves were also evaluated on a Philips scanner and a Siemens scanner. In-plane artifact sizes were evaluated as the maximum distance of the artifact from the expected scalp.RESULTSThe sizes and shapes of artifacts changed depending on valve pressure for all valves on the 3 different MRI scanners. Artifacts were less prominent on spin echo sequences than on gradient echo sequences. For diffusion-weighted imaging and time-of-flight MR angiography, the authors matched image numbers within the same sequence and compared appearances of artifacts. For all valves, the number of images affected by artifacts and the image number showing the largest artifact differed among valve settings.CONCLUSIONSArtifacts of all adjustable shunt valves showed gross changes corresponding to pressure setting. Not only the maximum distance of artifacts but also the shape changed significantly. The authors suggest that changing pressure settings offers one of the easiest ways to minimize artifacts on MRI 2)

Amano Y, Kuroda N, Uchida D, Sakakura Y, Nakatogawa H, Ando N, Nakayama T, Sato H, Masui T, Sameshima T, Tanaka T. Unexpectedly Smaller Artifacts of 3.0-T Magnetic Resonance Imaging than 1.5 T: Recommendation of 3.0-T Scanners for Patients with Magnet-Resistant Adjustable Ventriculoperitoneal Shunt Devices. World Neurosurg. 2019 Oct;130:e393-e399. doi: 10.1016/j.wneu.2019.06.095. Epub 2019 Jun 28. PMID: 31260847.
Uchida D, Amano Y, Nakatogawa H, Masui T, Ando N, Nakayama T, Sato H, Sameshima T, Tanaka T. Setting pressure can change the size and shape of MRI artifacts caused by adjustable shunt valves: a study of the 4 newest models. J Neurosurg. 2018 May 18:1-8. doi: 10.3171/2017.12.JNS171533. Epub ahead of print. PMID: 29775146.
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