European Radiology

, Volume 28, Issue 11, pp 4524–4533 | Cite as

CT metal artifacts in patients with total hip replacements: for artifact reduction monoenergetic reconstructions and post-processing algorithms are both efficient but not similar

  • Kai Roman Laukamp
  • Simon Lennartz
  • Victor-Frederic Neuhaus
  • Nils Große Hokamp
  • Robert Rau
  • Markus Le Blanc
  • Nuran Abdullayev
  • Anastasios Mpotsaris
  • David Maintz
  • Jan BorggrefeEmail author
Computed Tomography



This study compares metal artifact (MA) reduction in imaging of total hip replacements (THR) using virtual monoenergetic images (VMI), for MA-reduction-specialized reconstructions (MAR) and conventional CT images (CI) from detector-based dual-energy computed tomography (SDCT).


Twenty-seven SDCT-datasets of patients carrying THR were included. CI, MAR and VMI with different energy-levels (60–200 keV) were reconstructed from the same scans. MA width was measured. Attenuation (HU), noise (SD) and contrast-to-noise ratio (CNR) were determined in: extinction artifact, adjacent bone, muscle and bladder. Two radiologists assessed MA-reduction and image quality visually.


In comparison to CI, VMI (200 keV) and MAR showed a strong artifact reduction (MA width: CI 29.9±6.8 mm, VMI 17.6±13.6 mm, p<0.001; MAR 16.5±14.9 mm, p<0.001; MA density: CI -412.1±204.5 HU, VMI -279.7±283.7 HU; p<0.01; MAR -116.74±105.6 HU, p<0.001). In strong artifacts reduction was superior by MAR. In moderate artifacts VMI was more effective. MAR showed best noise reduction and CNR in bladder and muscle (p<0.05), whereas VMI were superior for depiction of bone (p<0.05). Visual assessment confirmed that VMI and MAR improve artifact reduction and image quality (p<0.001).


MAR and VMI (200 keV) yielded significant MA reduction. Each showed distinct advantages both regarding effectiveness of artifact reduction, MAR regarding assessment of soft tissue and VMI regarding assessment of bone.

Key Points

Spectral-detector computed tomography improves assessment of total hip replacements and surrounding tissue.

Virtual monoenergetic images and MAR reduce metal artifacts and enhance image quality.

Evaluation of bone, muscle and pelvic organs can be improved by SDCT.


X-ray computed tomography Artifacts Arthroplasty Hip Bone 



Conventional CT imaging/images


Contrast-to-noise ratio


Metal artifact


Metal artifact reduction algorithm


Spectral-detector CT


Total hip replacement


Virtual monoenergetic images



The authors state that this work has not received any funding.

Compliance with ethical standards


The scientific guarantor of this publication is Jan Borggrefe.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.


• retrospective

• diagnostic or prognostic study

• performed at one institution


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Copyright information

© European Society of Radiology 2018
corrected publication June 2018

Authors and Affiliations

  • Kai Roman Laukamp
    • 1
  • Simon Lennartz
    • 1
  • Victor-Frederic Neuhaus
    • 1
  • Nils Große Hokamp
    • 1
  • Robert Rau
    • 1
  • Markus Le Blanc
    • 1
  • Nuran Abdullayev
    • 1
  • Anastasios Mpotsaris
    • 1
  • David Maintz
    • 1
  • Jan Borggrefe
    • 1
    Email author
  1. 1.Department of RadiologyUniversity of CologneCologneGermany

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