Can you get an MRI with titanium rods? (+3 tips)
By
Ivan Kahwa
Author bio
Mr Ivan Kahwa is a chemist and phytopharmaceutical scientist with expertise in chemistry, pharmacology, phytochemistry, and Nanobiotechnology. He writes and reviews content on these topics.
Mr Ivan Kahwa’s Highlights:
Guest Researcher at the University of Leipzig, Senior Research Fellow/Scientist, and Lecturer at the Department of Pharmacy, Faculty of Medicine, Mbarara University of Science and Technology.
Professional Experience:
Mr Ivan joined PHARMBIOTRAC as a research fellow/scientist during his master of science tenure. He contributed to the development of most of the phytopharmaceutical products in the project. Furthermore, he participated in carrying out the pharmacological activities of the developed products in laboratory animals such as mice and rats in order to develop proper doses hence leading to pre-clinical studies.
With the above relevant research experience, Ivan started to work with the University of Leipzig on collaborative projects with Mbarara University to develop the chemistry of Ugandan Medicinal plants and their pharmacological activities. This was coupled with several consultative positions by different German NGOs. Mr. Kahwa is also a supporting in the teaching and learning at the Departments of Pharmacy and Pharmaceutical Sciences, Faculty of Medicine, Mbarara University of Science and Technology.
With the increase in antimicrobial resistance globally, Ivan retooled his thinking towards developing new naturally derived antibiotic regimens from Ugandan propolis with the assistance of nanotechnology to improve their delivery to microbial cells. Kahwa has also published over 28 articles in peer-reviewed journals and he is currently reviewing for many journals.
Education:
2023-2027: PhD in Pharmaceutical Sciences (ongoing) with a focus on Pharmaceutical Microbiology and Nanobiology at Mbarara University of Science and Technology.
2022: 2Msc. in Pharmacognosy and Natural Medicine Science at Mbarara University of Science and Technology.
2018: Bachelor of Science (Chemistry) at Mbarara University of Science and Technology.
Publications:
▪ Iqbal, S., Jabeen, F., Kahwa, I., & Omara, T. 2023. Suberosin Alleviates Thiazolidinedione-Induced Cardiomyopathy in Diabetic Rats by Inhibiting Ferroptosis via Modulation of ACSL4-LPCAT3 and PI3K-AKT Signaling Pathways. Cardiovascular Toxicology. https://doi.org/10.1007/s12012-023-09804-7
▪ Gupta, A. K., Yadav, R., Sharma, S., Sawale, J., & Kahwa, I. 2023. Anti-ageing Activity and Antioxidant Activity of Methanol Extracts of Leaves and Flowers of Salvia officinalis and Rosmarinus officinalis. Journal of Young Pharmacists, 15(3), 448–455. https://doi.org/10.5530/jyp.2023.15.60
▪ Tolo, C.U., Kahwa, I., Nuwagira, U., Weisheit, A. and Ikiriza, H., 2023. Medicinal plants used in treatment of various diseases in the Rwenzori Region, Western Uganda. Ethnobotany Research and Applications, 25, pp.1-16.
https://ethnobotanyjournal.org/index.php/era/article/view/4683
▪ Kahwa, I., Ajayi, C.O., Yadav, R., Chauhan, N.S., Shah, K., Abdelgadir, A.A., Shegena, E.A., Daniel, S., Omara, T., Asiimwe, J.B. and Ikiriza, H., 2023. Pharmacognostic and phytochemical studies as an invaluable approach for correct identification of medicinal plants: The case of Artemisia vulgaris L. substituted for Artemisia annua L. in Western Uganda. TMR Integr Med, 7, p.e23004.
https://doi.org/10.53388/TMRIM202307004
▪ Nalimu, F., Oloro, J., Kahwa, I. and Ogwang, P.E., 2021. Review on the phytochemistry and toxicological profiles of Aloe vera and Aloe ferox. Future Journal of Pharmaceutical Sciences, 7, pp.1-21.
https://doi.org/10.1186/s43094-021-00296-2
▪ Elamin, O.H.S., Ali, M.A., Elgezuli, I.A.A., Bashir, M.A. and Kahwa, I., 2021. Diagnosis of pre-and post-treatment of echinococcus granulosus with counter current immune electrophoresis and bacterial co-agglutination. Journal of Microbiology and Infectious Diseases, 11(02), pp.88-94.
https://doi.org/10.5799/jmid.951600
Published book Chapter
▪ Kahwa, I., Ayesiga, I., Nakalema, S., Alinaiswe, R., Mbabazi, R. and Iqbal, S., 2023. Natural products in the management of onchocerciasis. In Natural Products in Vector-Borne Disease Management (pp. 63-80). Academic Press. Book Chapter.
https://doi.org/10.1016/B978-0-323-91942-5.00012-4
Submitted manuscripts Under Review:
▪ Comparison of the Wound Healing Activity of the Leaf and Leaf Ash Extracts of Vernonia amygdalina in Rats. Journal name: Clinical Phytoscience
▪ Ethnobotanical Survey of Medicinal plants used in the management of cancer in Uganda. Journal name: Journal of Herbal Medicine
▪ Ethnobotanical survey and phytochemical screening of medicinal plants used in treatment of epilepsy by PROMETRA-Uganda Traditional Health Practitioners in Mpigi District, Uganda. Journal name: Journal of Ethnopharmacology
Submitted book chapters under review
1.Book title: Algae as a Natural Solution for Water-Food-Energy Nexus, Section 4: Microalgae and cyanobacteria for food applications, Chapter 4.6: Safety, toxicological and allergenic aspects of using algae for food. Authors: Christine Kyarimpa, Tom Omute, Caroline K. Nakiguli, Alice V. Khanakwa4, Christopher Angiro, Ivan Kahwa, Fortunate Ahumuza, Timothy Omara*. Publisher: Springer Nature Singapore Pte Ltd. 152 Beach Road, #21-01/04 Gateway East, Singapore 189721, Singapore.
2.Book title: Nutraceuticals Inspiring the Contemporary Therapy for Lifestyle Diseases. Chapter: Nutraceutical applications of Seaweeds and their Phytocompounds in Nutrition and Treatment of Diseases. Authors: Ivan Kahwa, Timothy Omara , Innocent Ayesiga , Gael Noel Neh Neba Ambe , Zehbanaz Javidbhai Panwala , Rachel Mbabazi , Shabnoor Iqbal , Christine Kyarimpa , Christine Betty Nagawa , Kamal Shah ,Nagendra Singh Chauhan* Publisher: CRC Press
You can view my works on the following professional sites:
Research Gate: https://www.researchgate.net/profile/Ivan-Kahwa
Google Scholar: https://scholar.google.com/citations?user=tOwrvqoAAAAJ&hl=en
ORCID: https://orcid.org/0000-0002-6440-3437
Linkedin: https://de.linkedin.com/in/ivan-kahwa-865450159
In this article, we will discuss whether you can get an MRI scan with titanium rods installed in your spinal cord for spinal fusion.
Can you get an MRI with titanium rods?
Yes, you may get an MRI with titanium rods. However, they may produce some level of artifact (a feature present in an image that is not otherwise present in the subject) during imaging. Still, titanium rods are known to cause the least amount of artifact as compared to other metals (1).
Titanium is a strong and extremely biocompatible paramagnetic material that does not interfere with the magnetic field and resonance of MRI, making it safe for the patient and MRI imaging. Titanium has low electrical conductivity as compared to other metals (2).
Metals used in spinal fusion often interfere with the imagining by producing artifacts, thereby reducing the diagnostic value of an MRI. This may cause misinterpretation of results. Before suggesting an MRI, the physician should evaluate the significance of an MRI over image distortion.
What does research suggest?
In one of the studies, researchers established that titanium and valium rods placed in porcine torso were found to have the least artifact and better diagnostic quality as compared to stainless steel rods (1).
In another study, lumbar spine implants that consisted of either titanium alloy or titanium with cobalt-chromium alloy (titanium-cobalt) were placed in a human cadaver spine section, followed by MRI.
The image quality was graded by nine physicians (from three different subspecialties). Titanium-based implants had higher imaging scores (18.16) compared to titanium-cobalt implants (17.45), indicating greater clarity of an MRI (3).
In another report, MRI of patients with cobalt-chromium alloy rods (n=6) had a 3.5 cm larger artifact in MRI scan as compared to patients who had titanium rods installed in their spine. However, the artifact did not interfere with the evaluation of the spinal canal and adjoining nerves (4).
Who cannot have an MRI with titanium rods?
Due to the use of strong magnets, MRI is not recommended in the following conditions (with or without titanium rods):
- Cardiac devices: Patients with an MRI-compatible pacemaker system or implantable cardiac defibrillator should wait for a minimum of six weeks before an MRI scan.
- Intracranial aneurysm clips: If the clip is made of a ferromagnetic metal, then MRI should not be recommended to such patients as the clip may interfere with the magnetic field.
- Cochlear implants: According to a recent study, MRI-related complications with common in patients with cochlear implants despite following the manufacturer’s guidelines (5).
- Implantable drug infusion pumps: Some patients may experience inaccurate medication dosing and mechanical problems from implantable pumps after an MRI scan.
- Neurostimulators: Deep brain stimulator electrodes and spinal cord simulator may interfere with the magnetic field. Therefore, caution is required.
- Insulin pumps: Insulin pumps should not be exposed to the high magnetic field of MRI. It may interfere with the motor present in the pump, altering the dose of insulin (6).
What is a safer alternative to MRI with titanium rods?
Your doctor may recommend a CT scan (computed tomography) instead of MRI. A CT scan takes a series of X-ray pictures of blood, bones and soft tissues. However, they are not as effective as an MRI in exposing subtle differences between certain types of tissues.
Ultrasound is also a good alternative to MRI. Ultrasound is used to evaluate soft tissues around the joints. It is less time-consuming, cheaper, and has 4-5 times better resolution than an MRI (7).
In the case of breasts, mammographs are preferred over MRI and CT scans. A mammogram is a low-dose imaging test that can spot changes in the breast tissues. 3D mammograms should be preferred over 2D mammograms for women with dense breasts (8).
How to reduce artifact in an MRI with titanium rods?
Image distortion and artifact in an MRI can be reduced by using the latest technology machine, proper maintenance, and optimizing the following (2):
- Magnetic resonance pulse sequence, and
- Optimizing scanning parameters.
Some small changes in the scan protocol can reduce image distortion and artifact. The radiologist must maintain a good signal-to-noise ratio and use spin echo instead of gradient echo. It is preferable to generate shorter echo spacing and smaller water-fat shifts.
Although a physician, we can never be sure about MRI-associated complications. However, advancements in technology have made it possible to design implants that are compatible with MRI scans. One such example is the Implanon (Entonogestrol) implant.
It is a single-rod, nonmetallic, sub-dermal device that is safe with MR procedures at all static magnetic field strengths. It is an effective contraceptive device. However, you should get the Implonon implant removed past its expiry date as it may cause side effects.
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References
1.-
Knott PT, Mardjetko SM, Kim RH, Cotter TM, Dunn MM, Patel ST, Spencer MJ, Wilson AS, Tager DS. A comparison of magnetic and radiographic imaging artifact after using three types of metal rods: stainless steel, titanium, and vitallium. The Spine Journal. 2010 Sep 1;10(9):789-94. https://www.sciencedirect.com/science/article/abs/pii/S1529943010004262
2.-
Kim YH, Choi M, Kim JW. Are titanium implants actually safe for magnetic resonance imaging examinations?. Archives of plastic surgery. 2019 Jan;46(01):96-7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6369045/
3.-
Trammell TR, Flint K, Ramsey CJ. A comparison of MRI and CT imaging clarity of titanium alloy and titanium alloy with cobalt-chromium-alloy pedicle screw and rod implants in the lumbar spine. JBJS. 2012 Aug 15;94(16):1479-83. https://journals.lww.com/jbjsjournal/fulltext/2012/08150/A_Comparison_of_MRI_and_CT_Imaging_Clarity_of.6.aspx?casa_token=WVIzDbVctXEAAAAA:7E3TGV0zh4K8K_SHML45gXLrMFHNMB1erZkNNH9WLPb9cqiWjputII9n4AJgV0idzblWGzCcQ56p-WWnBobutIo9
4.-
Ahmad FU, Sidani C, Fourzali R, Wang MY. Postoperative magnetic resonance imaging artifact with cobalt-chromium versus titanium spinal instrumentation: presented at the 2013 Joint Spine Section Meeting. Journal of Neurosurgery: Spine. 2013 Nov 1;19(5):629-36. https://journals.lww.com/jbjsjournal/fulltext/2012/08150/A_Comparison_of_MRI_and_CT_Imaging_Clarity_of.6.aspx?casa_token=WVIzDbVctXEAAAAA:7E3TGV0zh4K8K_SHML45gXLrMFHNMB1erZkNNH9WLPb9cqiWjputII9n4AJgV0idzblWGzCcQ56p-WWnBobutIo9
5.-
Alberalar ND, Reis J, Piechotta PL, Beetz NL, Fehrenbach U, Geisel D, Thomas A, Busse H, Denecke T. Complications of cochlear implants with MRI scans in different body regions: type, frequency and impact. Insights into Imaging. 2023 Jan 16;14(1):9. https://insightsimaging.springeropen.com/articles/10.1186/s13244-022-01353-x
6.-
Dal Molin R, Hecker B. Implantable medical devices MRI safe. InpHealth 2013 2013 (pp. 96-100). IOS Press. https://pubmed.ncbi.nlm.nih.gov/23739365
7.-
Wink MH, Wijkstra H, De La Rosette JJ, Grimbergen CA. Ultrasound imaging and contrast agents: a safe alternative to MRI?. Minimally Invasive Therapy & Allied Technologies. 2006 Jan 1;15(2):93-100. https://pubmed.ncbi.nlm.nih.gov/16754192/
8.-
Rimer BK, Trock B, Engstrom PF, Lerman C, King E. Why do some women get regular mammograms?. American Journal of Preventive Medicine. 1991 Mar 1;7(2):69-74. https://www.sciencedirect.com/science/article/abs/pii/S0749379718309401
