{
    "abstract": "In times of an aging society and considering the escalating health economic costs, the indications for imaging, particularly magnetic resonance imaging (MRI), must be carefully considered and strictly adhered to. This cadaver study aims to examine the influence of cochlear implant (CI) on the assessment of intracranial structures, artifact formation, and size in cranial MRI (cMRI). Furthermore, it seeks to evaluate the potential limitations in the interpretability and diagnostic value of cMRI in CI patients. Additionally, the study investigates the imaging of the brain stem and the internal ear canal and the feasibility of excluding cholesteatomas in cMRI for CI patients.\nTwo cadaveric specimens were implanted with cochlear implants at varying angular positions (90\u00b0, 120\u00b0, and 135\u00b0), both unilaterally and bilaterally, with and without magnet in situ. MRI acquisition consisted of sequences commonly used in brain MRI scans (T\nThe cadaveric head mapping facilitated the analysis of all 22 predefined intracranial structures. Artifacts were assessed in terms of their minimum and maximum impact on image comparability. Image quality and assessability were stratified into four categories (0-25%, 25-50%, 50-75%, and 75-100% of assessability restriction). The visualization of the central, temporal, parietal, and frontal lobes was contingent upon CI positioning and the choice of imaging sequence. Diffusion-weighted cMRI proved inadequate for monitoring cholesteatoma recurrence in ipsilateral CI patients, regardless of magnet presence. The ipsilateral internal auditory canal was inadequately visualized in both magnet-present and magnet-absent conditions. We divided our results into four categories. Category 3 (orange) indicates considerable limitations, while category 4 (red) indicates no interpretability, as the image is entirely obscured by artifacts.\nThis study provides detailed predictive power for the assessability and therefore the relevance of performing cMRIs in CI patients. We advocate consulting the relevant CI center if artifact overlay exceeds 50% (categories 3 and 4), to evaluate magnet explantation and reassess the necessity of cMRI. When suspecting cholesteatoma or cholesteatoma recurrences in patients with ipsilateral cochlear implants, diagnostic investigation should preferably be pursued surgically, as the necessary MRI sequences are prone to artifact interference, even in the absence of a magnet. The ipsilateral internal auditory canal remains inadequately evaluable with a magnet in situ, while without the magnet, only rudimentary assessments can be made across most sequences.",
    "authors": [
        {
            "affiliation": "Department of Otorhinolaryngology - Head and Neck Surgery, Medical Center, Faculty of Medicine, University of Freiburg, Killianstrasse 5, 79106, Freiburg, Germany.\nDepartment of Radiology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.",
            "firstname": "P",
            "initials": "P",
            "lastname": "Arnold"
        },
        {
            "affiliation": "Department of Otorhinolaryngology - Head and Neck Surgery, Medical Center, Faculty of Medicine, University of Freiburg, Killianstrasse 5, 79106, Freiburg, Germany.",
            "firstname": "L",
            "initials": "L",
            "lastname": "Fries"
        },
        {
            "affiliation": "Department of Otorhinolaryngology - Head and Neck Surgery, Medical Center, Faculty of Medicine, University of Freiburg, Killianstrasse 5, 79106, Freiburg, Germany.",
            "firstname": "R L",
            "initials": "RL",
            "lastname": "Beck"
        },
        {
            "affiliation": "Oticon Medical, 2720 Chemin Saint-Bernard, 06220, Vallauris, France.",
            "firstname": "S",
            "initials": "S",
            "lastname": "Granitzer"
        },
        {
            "affiliation": "Faculty of Medicine, Eye Center, Albert-Ludwigs University Freiburg, 79085, Freiburg, Germany.",
            "firstname": "M",
            "initials": "M",
            "lastname": "Reich"
        },
        {
            "affiliation": "Department of Otorhinolaryngology - Head and Neck Surgery, Medical Center, Faculty of Medicine, University of Freiburg, Killianstrasse 5, 79106, Freiburg, Germany.",
            "firstname": "A",
            "initials": "A",
            "lastname": "Aschendorff"
        },
        {
            "affiliation": "Department of Otorhinolaryngology - Head and Neck Surgery, Medical Center, Faculty of Medicine, University of Freiburg, Killianstrasse 5, 79106, Freiburg, Germany.",
            "firstname": "S",
            "initials": "S",
            "lastname": "Arndt"
        },
        {
            "affiliation": "Department of Otorhinolaryngology - Head and Neck Surgery, Medical Center, Faculty of Medicine, University of Freiburg, Killianstrasse 5, 79106, Freiburg, Germany. manuel.christoph.ketterer@uniklinik-freiburg.de.",
            "firstname": "M C",
            "initials": "MC",
            "lastname": "Ketterer"
        }
    ],
    "conclusions": "This study provides detailed predictive power for the assessability and therefore the relevance of performing cMRIs in CI patients. We advocate consulting the relevant CI center if artifact overlay exceeds 50% (categories 3 and 4), to evaluate magnet explantation and reassess the necessity of cMRI. When suspecting cholesteatoma or cholesteatoma recurrences in patients with ipsilateral cochlear implants, diagnostic investigation should preferably be pursued surgically, as the necessary MRI sequences are prone to artifact interference, even in the absence of a magnet. The ipsilateral internal auditory canal remains inadequately evaluable with a magnet in situ, while without the magnet, only rudimentary assessments can be made across most sequences.",
    "copyrights": "\u00a9 2024. The Author(s).",
    "doi": "10.1007/s00405-024-09164-0\n10.1097/MAO.0b013e3181fcf271\n10.1007/s00405-022-07315-9\n10.1007/s00405-020-06464-z\n10.1007/s00405-021-07005-y\n10.1097/MAO.0000000000000666\n10.1097/MAO.0000000000002269\n10.1097/MAO.0b013e3181825695\n10.1097/MAO.0b013e3182a5d2c5\n10.1007/s00106-023-01364-0\n10.1007/s00405-018-5135-9\n10.1007/s00405-024-08568-2\n10.1001/jamaoto.2014.2926\n10.1002/lary.25993\n10.1097/MAO.0000000000002179\n10.1016/S1053-8119(03)00169-1\n10.1007/s00405-020-06315-x\n10.1055/s-0029-1245511\n10.1097/MAO.0000000000001176\n10.1002/lary.27516\n10.1016/j.crad.2019.06.011\n10.2463/mrms.mp.2021-0162\n10.1097/MAO.0000000000000720\n10.1371/journal.pone.0132483\n10.1007/s00330-018-5710-x\n10.1038/s42003-022-03880-1\n10.1016/j.nicl.2018.10.019\n10.1016/j.jneumeth.2019.108565\n10.1007/s10548-022-00919-8\n10.1016/j.ynirp.2022.100137\n10.1111/JON.12521\n10.1007/s10548-021-00852-2\n10.1371/journal.pone.0179590\n10.1038/sdata.2016.44\n10.3174/ajnr.A2129\n10.1093/gigascience/giae049",
    "journal": "European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery",
    "keywords": [
        "Artifact",
        "Cochlear implant",
        "Cranial imaging",
        "MRI",
        "Magnet"
    ],
    "methods": null,
    "publication_date": "2025-01-01",
    "pubmed_id": "39738529\n21068690\n35226182\n33206227\n34370074\n25931165\n31219967\n18667941\n24270727\n37943372\n30229458\n39668219\n25411817\n27075602\n30870379\n12880848\n32889623\n20563960\n27525711\n30412276\n31324337\n35296610\n25634466\n26200775\n30242503\n36068295\n30606656\n36208399\n29766613\n34008053\n28683072\n27326542\n20488909\n39102518",
    "results": "The cadaveric head mapping facilitated the analysis of all 22 predefined intracranial structures. Artifacts were assessed in terms of their minimum and maximum impact on image comparability. Image quality and assessability were stratified into four categories (0-25%, 25-50%, 50-75%, and 75-100% of assessability restriction). The visualization of the central, temporal, parietal, and frontal lobes was contingent upon CI positioning and the choice of imaging sequence. Diffusion-weighted cMRI proved inadequate for monitoring cholesteatoma recurrence in ipsilateral CI patients, regardless of magnet presence. The ipsilateral internal auditory canal was inadequately visualized in both magnet-present and magnet-absent conditions. We divided our results into four categories. Category 3 (orange) indicates considerable limitations, while category 4 (red) indicates no interpretability, as the image is entirely obscured by artifacts.",
    "title": "Post mortem cadaveric and imaging mapping analysis of the influence of cochlear implants on cMRI assessment regarding implant positioning and artifact formation.",
    "xml": "<Element 'PubmedArticle' at 0x788506d6c860>"
}