MR Imaging and Cochlear Implants with Retained Internal Magnets: Reducing Artifacts near Highly Inhomogeneous Magnetic Fields

The number of patients receiving cochlear implants and auditory brainstem implants for severe to profound sensorineural hearing loss has rapidly increased. These implants consist of an internal component implanted between the skull and the temporal scalp and an external removable speech processor unit. A small magnet within the internal component is commonly used to hold the external speech processor unit in place. Several cochlear implant models have recently received U.S. Food and Drug Administration and European Economic Area regulatory approval to allow magnetic resonance (MR) imaging examinations to be performed under certain specified conditions. The small internal magnet presents a challenge for imaging of the head and neck near the implant, creating a nonlinear magnetic field inhomogeneity and significant MR imaging artifacts. Fat-saturation failures and susceptibility artifacts severely degrade image quality. Typical artifacts at diffusion-weighted imaging and accelerated imaging are exacerbated. Each examination may require impromptu adjustments to allow visualization of the tissue or contrast of interest. Patients may also be quite uncomfortable during the examination, as a result of either imposed magnetic forces or a tight head wrap that is often applied to minimize internal magnet movement. Translational forces and torque sometimes displace the implanted magnet even when a head wrap is used. Diseases such as neurofibromatosis type 2 that are associated with bilateral vestibular schwannomas and hearing loss often require lifelong tumor surveillance with MR imaging. A collaborative team of radiologists, technologists, and/or medical physicists or MR imaging scientists, armed with strategies to mitigate artifacts near implanted magnets, can customize the examination for better visualization of tissue and consistent comparison examinations over time. (C)RSNA, 2018