Postoperative MRI in cranio-maxillofacial and oral reconstruction: A prospective comparative pilot study on artifact reduction

To assess, in a prospective pilot study, five magnetic resonance imaging (MRI) artifact reduction protocols (UTE, SEMAC, Dark Bone, DESS, and STIR) using a 15-channel dentomaxillofacial coil in trauma patients undergoing cranio-maxillofacial and oral reconstruction. Eighteen patients (15 M/3 F, 37.9 +/- 17.5 years) underwent MRI within 48 h after surgery. Image quality, artifact extent, and visualization of peri-osteosynthesis tissues were qualitatively evaluated on a 5-point scale (5 = best, 1 = worst). Quantitative analysis assessed protocol-specific artifact-induced signal voids in relation to the dimensions of manufacturer-specific implants. Descriptive statistics and inter- and intra-observer reliability were evaluated using weighted kappa statistics. UTE and SEMAC consistently demonstrated highest image quality and minimal artifacts, accurately depicting peri-osteosynthesis tissues, with mean artifact deviations below 2 mm relative to ground-truth implant dimensions. STIR showed intermediate performance, providing robust fat suppression and soft-tissue contrast, whereas Dark Bone and DESS exhibited higher artifact prevalence and lower diagnostic confidence. Subgroup analysis confirmed these trends across fracture location and implant type. Inter- and intra-observer agreement ranged from substantial to perfect (kappa = 0.71-1.0, p < 0.001). Modern MRI techniques like UTE and SEMAC with specialized coils improve postoperative imaging by balancing artifact suppression, image quality, and diagnostic confidence, potentially enhancing assessment of perioperative complications, reconstructive outcomes, and oncological follow-up in cranio-maxillofacial surgery.