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Combined application of virtual monoenergetic high keV images and the orthopedic metal artifact reduction algorithm (O-MAR): effect on image quality

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Abstract

Purpose

To determine whether there is any additional metal artifact reduction when virtual monochromatic images (VMI) and metal artifact reduction for orthopedic implants (O-MAR) are applied together compared to their separate application in both phantom and clinical abdominopelvic CT studies.

Methods

An agar phantom containing a spinal prosthesis was scanned using a dual-layer, energy CT scanner (IQon, Philips Healthcare), and reconstructed with the filtered back-projection algorithm without O-MAR (FBP), filtered back-projection algorithm with O-MAR (O-MAR), VMI140 without O-MAR (VMI140), and VMI140 with O-MAR (VMI140 + O-MAR). Abdominopelvic CT images of 47 patients with metallic prostheses were also reconstructed in the same manner for clinical study. Noise measured as the standard deviation of CT Hounsfield units was compared between the four reconstruction methods in both phantom and clinical studies. Improvements in metal artifact reduction, image quality, and diagnostic improvement were further analyzed in the clinical study.

Results

Noise was significantly decreased when both VMI and O-MAR were applied in conjunction compared to their separate application in both phantom (16.3 HU vs. 25.0 and 26.4 HU) and clinical studies (15.8 HU vs. 19.2 and 26.2 HU). In the clinical study, the qualitative degree of artifacts was also significantly reduced with VMI140 + O-MAR (2.85 and 2.87) compared to VMI140 (2.36 and 2.26) or O-MAR (2.13 and 2.04) alone for both reviewers (P < 0.001) and improvements in image quality were observed in all 47 patients, with actual diagnostic improvements observed in three.

Conclusions

Metal artifacts can be additionally reduced by applying O-MAR and VMI in conjunction, compared to their separate application, thereby improving diagnostic performance.

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Authors and Affiliations

  1. Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea

    Junghoan Park, Se Hyung Kim & Joon Koo Han

  2. Seoul National University College of Medicine, Seoul, Republic of Korea

    Junghoan Park, Se Hyung Kim & Joon Koo Han

  3. Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea

    Joon Koo Han

Authors
  1. Junghoan Park
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Correspondence to Se Hyung Kim.

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Funding

This study was supported by Philips Health Systems Korea.

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. For this type of study formal consent is not required.

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Park, J., Kim, S.H. & Han, J.K. Combined application of virtual monoenergetic high keV images and the orthopedic metal artifact reduction algorithm (O-MAR): effect on image quality. Abdom Radiol 44, 756–765 (2019). https://doi.org/10.1007/s00261-018-1748-0

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  • DOI: https://doi.org/10.1007/s00261-018-1748-0

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