MRI artefacts after Bonebridge implantation

Abstract

The new transcutaneous bone conduction implant (BCI) Bonebridge (BB, MED-EL) allows the skin to remain intact and therefore overcomes some issues related to percutaneous systems, such as skin reaction around the external screw and cosmetic complaints. According to manufacturer, BB is MRI conditional up to 1,5 Tesla (T). The artefact of the neurocranium after BB implantation is extensive as shown in the present report. This has to be taken into account when patients suffering conductive, mixed or single-sided hearing loss with candidacy for a BCI are counselled. In patients with comorbid intracranial tumour or other diseases of the brain that require imaging control scans with MRI percutaneous, BCI should be the implant of choice considering the very small artefact of the percutaneous screw in MRI.

Magnetic resonance imaging investigation of the bone conduction implant – a pilot study at 1.5 Tesla

“…In the worst case, the image can get distorted to the extent that a correct diagnosis cannot be confirmed, as shown in the study by Kim et al, 16 where a young child with bilateral CIs was scanned to assess for bacterial meningitis. This was also the case in a study by Steinmetz et al 24 when a 29-year old patient with vestibular schwannoma was scanned with a Bone-bridge™ implanted on the contralateral side. The image artifact distorted the whole brain image, and in particular, the cerebellopontine angle where the tumor was located.…”

“…However, some hearing impairments are linked to intracranial diseases, such as unilateral hearing loss and vestibular schwannoma, which requires regular MRI examinations for planning of surgery or radiation therapy and to follow the tumor growth over time. 24 The MRI safety for those patients is therefore important to consider if their hearing impairment is rehabilitated with hearing implants. Some other reported reasons, not related to hearing impairment, why patients with hearing implants have had their upper trunk scanned with MRI are exclusion of a brain tumor, traffic accidents, shoulder pain, congenital atresia of the ear, bacterial meningitis, diabetes insipidus in Langerhans cell histiocytosis, optic neuritis, and preoperative planning for implantation of an auditory brainstem implant.…”

The Bonebridge Bone Conduction Hearing Implant: indication criteria, surgery and a systematic review of the literature

“…To find the optimal placement, it is recommended to have a thorough look at the CT scan, as implemented in all the published studies. Compared to MRI, CT offers clear visualisation of the landmarks, especially in difficult cases . The BB Fast View Software is a tool that can aid in finding the best position of the BC‐FMT by using a BC‐FMT dummy that can be positioned into the CT scan.…”

“…A total of 29 studies, 17 published and 12 presentations, were identified evaluating the Bonebridge hearing implant system. A total of 18 studies primarily evaluated the safety and effectiveness of the Bonebridge, seven investigated imaging and modelling methods, two evaluated the AP settings, and one carried out psychoacoustic measurements on the BC‐FMT . All characteristics of the studies are listed in Table .…”

Active Bone Conduction System: Outcomes with the Bonebridge Transcutaneous Device

“…The main limitation of the BB device is due to the artifact that can occur when a patient undergoes an MRI test. It does not preclude MRI, but there is a limitation to 1.5 T [12,13]. According to our experience, the position of the BB device was determined via exact evaluation of preoperative CT images in relation to the anatomical structures and their possible anomalies.…”