Postoperative magnetic resonance imaging artifact with cobalt-chromium versus titanium spinal instrumentation

Object. Cobalt-chromium alloy (CoCr) rods haves some preferred biomechanical properties over titanium rods for spinal fixation. The use of CoCr rods in spinal fusion is relatively new, and there is no study in the existing world literature assessing the artifact caused by these rods in patients undergoing postoperative MRI. The purpose of this study is to compare the amount of imaging artifact caused by these implants and to assess its impact on the visualization of neighboring neural structures. Methods. This study investigated MR images in patients who underwent implantation of thoracolumbar instrumentation using 5.5-mm-diameter CoCr rods between November 2009 and March 2011 and images obtained in a comparison group of patients who had 5.5-mm titanium rods implanted during the same time period. Axial measurements of the artifact created by the rods between the screw heads were compared between the groups. Two blinded board-certified radiologists performed the measurements independently. They scored the visualization of the spinal canal using a subjective scoring system of 1-3, with 1 representing very good visualization and 2 and 3 representing reduced (good or suboptimal, respectively) visualization as a result of rod-related artifact. All measurements and scores were independently provided for T1-weighted and T2-weighted fast spin echo sequences (1.5-T magnet, 5-mm slice thickness). Results. A total of 40 levels from the CoCr group (6 patients) and 30 levels from the titanium group (9 patients) were included in the analysis. Visualization of the canal at all levels was rated a score of 1 (very good) by both evaluators for both the CoCr and titanium groups. The average artifact on T1-weighted images measured 11.8 +/- 1.8 mm for the CoCr group and 8.5 +/- 1.2 mm for the titanium group (p < 0.01). The corresponding measurements on T2-weighted images were 11.0 +/- 2.3 mm and 8.3 +/- 1.7 mm (p < 0.01), respectively. In a mixed regression model, the mean artifact measurement for the CoCr group was, on average, 3.5 mm larger than for the control group. There was no significant difference between the measurements of the 2 evaluators (p = 0.99). Conclusions. The artifact caused by CoCr rods is approximately 3.5 mm larger than that caused by titanium rods on axial T1- and T2-weighted MRI. However, artifact from either CoCr or titanium was not found to interfere with the evaluation of the spinal canal and surrounding neural elements.