Abstract
Objective
The study aimed to assess image quality when using dual-energy CT (DECT) to reduce metal artifacts in subjects with knee and hip prostheses.
Methods
Twenty-two knee and 10 hip prostheses were examined in 31 patients using a DECT protocol (tube voltages 100 and 140 kVp). Monoenergetic reconstructions were extrapolated at 64, 69, 88, 105, 110, 120, 140, 170, and 190 kilo-electron volts (keV) and the optimal energy was manually selected. The B60–140 and Fast DE reconstructions were made by CT. The image quality and diagnostic value were subjectively and objectively determined. Double-blind qualitative assessment was performed by two radiologists using a Likert scale. For quantitative analysis, a circular region of interest (ROI) was placed by a third radiologist within the most evident streak artifacts on every image. Another ROI was placed in surrounding tissues without artifacts as a reference.
Results
The inter-reader agreement for the qualitative assessment was nearly 100%. The best overall image quality (37.8% rated “excellent”) was the Fast DE Siemens reconstruction, followed by B60–140 and Opt KeV (20.5 and 10.2% rated excellent). On the other hand, DECT images at 64, 69 and 88 keV had the worse scores. The number of artifacts was significantly different between monoenergetic images. Nevertheless, because of the high number of pairwise comparisons, no differences were found in the post hoc analysis except for a trend toward statistical significance when comparing the 170 and 64 keV doses.
Conclusions
DECT with specific post-processing may reduce metal artifacts and significantly enhance the image quality and diagnostic value when evaluating metallic implants.
Similar content being viewed by others
References
Lee MJ, Kim S, Lee SA et al (2007) Overcoming artifacts from metallic orthopedic implants at high-field-strength MR imaging and multi-detector CT. Radiographics 27:791–803
White LM, Buckwalter KA (2002) Technical considerations: CT and MR imaging in the postoperative orthopedic patient. Semin Musculoskelet Radiol 6:5–17
Barrett JF, Keat N (2004) Artifacts in CT: recognition and avoidance. Radiographics 24:1679–1691
Moon SG, Hong SH, Choi J-Y, Jun WS, Kang H-G, Kim H-S et al (2008) Metal artifact reduction by the alteration of technical factors in multidetector computed tomography: a 3-dimensional quantitative assessment. J Comput Assist Tomogr 32(4):630–633
Perrella A, Lopes PML, Rocha RG, Fenyo-Pereira M, Cavalcanti MGP (2010) Influence of dental metallic artifact from multislice CT in the assessment of simulated mandibular lesions. J Appl Oral Sci. 18(2):149–154
Vande Berg B, Malghem J, Maldague B, Lecouvet F (2006) Multi-detector CT imaging in the postoperative orthopedic patient with metal hardware. Eur J Radiol 60(3):470–479
Link TM, Berning W, Scherf S, Joosten U, Joist A, Engelke K et al (2000) CT of metal implants: reduction of artifacts using an extended CT scale technique. J Comput Assist Tomogr 24(1):165–172
Fishman EK, Magid D, Robertson DD, Brooker AF, Weiss P, Siegelman SS (1986) Metallic hip implants: CT with multiplanar reconstruction. Radiology 160(3):675–681
Stradiotti P, Curti A, Castellazzi G, Zerbi A (2009) Metal-related artifacts in instrumented spine. Techniques for reducing artifacts in CT and MRI: state of the art. Eur Spine J 18(Suppl 1):102–108
Yu L, Leng S, McCollough CH (2012) Dual-energy CT-based monochromatic imaging. AJR Am J Roentgenol 199(5 Suppl):S9–S15
Ferrara F, Cipriani A, Rapisarda S et al (2015) Assessment of implant position after total knee arthroplasty by dual-energy computed tomography. Acta Radiol 57(5):612–619
Filograna L, Magarelli N, Leone A et al (2016) Performances of low-dose dual-energy CT in reducing artifacts from implanted metallic orthopedic devices. Skeletal Radiol 45(7):937–947
Filograna L, Magarelli N, Leone A et al (2015) Value of monoenergetic dual-energy CT (DECT) for artefact reduction from metallic orthopedic implants in post-mortem studies. Skeletal Radiol 44(9):1287–1294
Stolzmann P, Leschka S, Scheffel H et al (2010) Characterization of urinary stones with dual-energy CT: improved differentiation using a tin filter. Invest Radiol 45:1–6
Bamberg F, Dierks A, Nikolaou K, Reiser MF, Becker CR, Johnson TR (2011) Metal artifact reduction by dual energy computed tomography using monoenergetic extrapolation. EurRadiol 21:1424
Meinel FG, Bischoff B, Zhang Q, Bamberg F, Reiser MF, Johnson TR (2012) Metal artifact reduction by dual-energy computed tomography using energetic extrapolation: a systematically optimized protocol. Invest Radiol 47(7):406–414
Zhou C, Zhao YE, Luo S et al (2011) Monoenergetic imaging of dual-energy CT reduces artifacts from implanted metal orthopedic devices in patients with factures. AcadRadiol 18:1252–1257
Guggenberger R, Winklhofer S, Osterhoff G et al (2012) Metallic artefact reduction with monoenergetic dual-energy CT: systematic ex vivo evaluation of posterior spinal fusion Implants from various vendors and different spine levels. EurRadiol 22:2357–2364
Lin XZ, Miao F, Li JY, Dong HP, Shen Y, Chen KM (2011) High-definition CT Gemstone spectral imaging of the brain: initial results of selecting optimal monochromatic image for beam-hardening artifacts and image noise reduction. J Comput Assist Tomogr 35:294–297
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the appropriate ethical committee. All authors have approved the manuscript and have significantly contributed to it. This article does not contain any studies with animals performed by any of the authors.
Rights and permissions
About this article
Cite this article
Magarelli, N., De Santis, V., Marziali, G. et al. Application and advantages of monoenergetic reconstruction images for the reduction of metallic artifacts using dual-energy CT in knee and hip prostheses. Radiol med 123, 593–600 (2018). https://doi.org/10.1007/s11547-018-0881-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11547-018-0881-8