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Robar JL, Cherpak A, MacDonald RL, Yashayaeva A, McAloney D, McMaster N, Zhan K, Cwajna S, Patil N, Dahn H. Novel Technology Allowing Cone Beam Computed Tomography in 6 Seconds: A Patient Study of Comparative Image Quality. Pract Radiat Oncol 2024; 14:277-286. [PMID: 37939844 DOI: 10.1016/j.prro.2023.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/20/2023] [Accepted: 10/30/2023] [Indexed: 11/10/2023]
Abstract
PURPOSE The goal of this study was to evaluate the image quality provided by a novel cone beam computed tomography (CBCT) platform (HyperSight, Varian Medical Systems), a platform with enhanced reconstruction algorithms as well as rapid acquisition times. Image quality was compared with both status quo CBCT for image guidance, and to fan beam CT (FBCT) acquired on a CT simulator (CTsim). METHODS AND MATERIALS In a clinical study, 30 individuals were recruited for whom either deep inspiration (DIBH) or deep exhalation breath hold (DEBH) was used during imaging and radiation treatment of tumors involving liver, lung, breast, abdomen, chest wall, and pancreatic sites. All subjects were imaged during breath hold with CBCT on a standard image guidance platform (TrueBeam 2.7, Varian Medical Systems) and FBCT CT (CTsim, GE Optima). HyperSight imaging with both breath hold (HSBH) and free breathing (HSFB) was performed in a single session. The 4 image sets thus acquired were registered and compared using metrics quantifying artifact index, image nonuniformity, contrast, contrast-to-noise ratio, and difference of Hounsfield unit (HU) from CTsim. RESULTS HSBH provided less severe artifacts compared with both HSFB and TrueBeam. The severity of artifacts in HSBH images was similar to that in CTsim images, with statistically similar artifact index values. CTsim provided the best image uniformity; however, HSBH provided improved uniformity compared with both HSFB and TrueBeam. CTsim demonstrated elevated contrast compared with HyperSight imaging, but both HSBH and HSFB imaging showed superior contrast-to-noise ratio characteristics compared with TrueBeam. The median HU difference of HSBH from CTsim was within 1 HU for muscle/fat tissue, 12 HU for bone, and 14 HU for lung. CONCLUSIONS The HyperSight system provides 6-second CBCT acquisition with image artifacts that are significantly reduced compared with TrueBeam and comparable to those in CTsim FBCT imaging. HyperSight breath hold imaging was of higher quality compared with free breathing imaging on the same system. The median HU value in HyperSight breath hold imaging is within 15 HU of that in CTsim imaging for muscle, fat, bone, and lung tissue types, indicating the utility of image data for direct dose calculation in adaptive workflows.
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Affiliation(s)
- James L Robar
- Department of Radiation Oncology, QE2 Cancer Centre, Nova Scotia Health, Halifax, Canada; Departments of Radiation Oncology; Physics and Atmospheric Science, Dalhousie University, Halifax, Canada.
| | - Amanda Cherpak
- Department of Radiation Oncology, QE2 Cancer Centre, Nova Scotia Health, Halifax, Canada; Departments of Radiation Oncology; Physics and Atmospheric Science, Dalhousie University, Halifax, Canada
| | - Robert Lee MacDonald
- Department of Radiation Oncology, QE2 Cancer Centre, Nova Scotia Health, Halifax, Canada; Departments of Radiation Oncology; Physics and Atmospheric Science, Dalhousie University, Halifax, Canada
| | | | - David McAloney
- Department of Radiation Oncology, QE2 Cancer Centre, Nova Scotia Health, Halifax, Canada
| | - Natasha McMaster
- Department of Radiation Oncology, QE2 Cancer Centre, Nova Scotia Health, Halifax, Canada
| | - Kenny Zhan
- Department of Radiation Oncology, QE2 Cancer Centre, Nova Scotia Health, Halifax, Canada
| | - Slawa Cwajna
- Department of Radiation Oncology, QE2 Cancer Centre, Nova Scotia Health, Halifax, Canada; Departments of Radiation Oncology
| | - Nikhilesh Patil
- Department of Radiation Oncology, QE2 Cancer Centre, Nova Scotia Health, Halifax, Canada; Departments of Radiation Oncology
| | - Hannah Dahn
- Department of Radiation Oncology, QE2 Cancer Centre, Nova Scotia Health, Halifax, Canada; Departments of Radiation Oncology
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Lenham FM, Iball GR. Improving the quality of computed tomography brain images in the presence of cochlear implant induced metal artefacts through the additional use of tissue mimicking materials alongside metal artefact reduction software. Radiography (Lond) 2024; 30:813-820. [PMID: 38513334 DOI: 10.1016/j.radi.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 02/15/2024] [Accepted: 03/08/2024] [Indexed: 03/23/2024]
Abstract
INTRODUCTION Metal artefact reduction software (MAR) can be used to improve Computed Tomography (CT) image quality in the presence of implanted metalwork; however, this software is not effective for superficial metallic structures such as cochlear implants (CI). This study aimed to investigate whether the effectiveness of MAR software could be improved for brain scans with CI present through the use of tissue mimicking materials (TMM) placed exteriorly to the implant. METHODS In this two-part study, a CI was positioned on the surface of water and anthropomorphic phantoms and imaged using a helical CT brain protocol. Three TMM, Superflab, Sure Thermal heat packs, and Bart's Bolus, were utilised and images were acquired to assess the resulting artefact reduction in terms of CT numbers, noise and artefact index (Aind). Changes in CTDIvol were assessed for the anthropomorphic phantom scans. RESULTS In the water phantom, statistically significant reductions in CT number (p = 0.038) and noise (p = 0.033) were observed for Superflab, whilst the heat packs produced similar significant reductions in CT number (p < 0.001) and noise (p = 0.001) for the anthropomorphic phantom images. Aind values were significantly reduced through the use of Superflab (p = 0.009) and the heat packs (p < 0.001). No significant effects were observed for Bart's Bolus. CTDIvol increases of generally less than 5% were observed for scans with TMM in place. CONCLUSION The additional use of TMM alongside MAR software yielded statistically significant reductions in CI induced metal artefacts on both water and anthropomorphic phantom scans with minimal dose increases. IMPLICATIONS FOR PRACTICE The extent of metal artefacts in clinical head scans with CI in place could be significantly reduced through combined use of TMM and MAR software, consequently providing greater diagnostic confidence in the images.
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Affiliation(s)
- F M Lenham
- Department of Medical Physics & Engineering, Old Medical School, Leeds General Infirmary, Leeds, LS1 3EX, UK.
| | - G R Iball
- Department of Medical Physics & Engineering, Old Medical School, Leeds General Infirmary, Leeds, LS1 3EX, UK; Faculty of Health Studies, University of Bradford, Bradford, BD7 1DP, UK.
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Morioka Y, Ichikawa K, Kawashima H. Quality improvement of images with metal artifact reduction using a noise recovery technique in computed tomography. Phys Eng Sci Med 2024; 47:169-180. [PMID: 37938518 DOI: 10.1007/s13246-023-01353-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/31/2023] [Indexed: 11/09/2023]
Abstract
In metal artifact reduction (MAR) in computed tomography (CT) based on projection data inpainting, X-ray photon noise has not been considered in the inpainting process. This study aims to assess the effectiveness of a MAR technique incorporating noise recovery in such projection data regions, compared with existing MAR techniques based on projection data normalization (NMAR), including one with frequency splitting (FSNMAR). Phantoms simulating hip prostheses and dental fillings were scanned using a 64-row multi slice CT scanner. The projection data was processed by NMAR and NMAR with noise recovery (NRNMAR); the processed data was sent back to the CT system for reconstruction. For the phantoms and clinical cases with hip prostheses and dental fillings, images were reconstructed without MAR, and with NMAR, NRNMAR, and FSNMAR (incorporated in the CT system). To validate the efficacy of noise recovery, noise power spectra (NPSs) were measured from the images of the hip prosthesis phantom with and without metals. The artifact index (AI) was compared between NRNMAR and FSNMAR. The resultant NPSs of NRNMAR were very similar to those of phantom images with no metals, endorsing the efficacy of noise recovery. The NMAR images had unnatural noise textures and FSNMAR caused additional streaks. NRNMAR exhibited some significant improvements in these respects: It reduced the AI by as much as 66.2-88.6% compared to FSNMAR, except for the case of a unilateral prosthesis. In conclusion, NRNMAR, which simply adds white noise to the projection data, would be effective in improving the quality of CT images with metal artifacts reduction.
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Affiliation(s)
- Yusuke Morioka
- Department of Medical Technology, Toyama Prefectural Central Hospital, 2-2-78 Nishinagae, Toyama, 930-8550, Japan
- Division of Health Sciences, Graduate School of Medical Science, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, Ishikawa, 920-0942, Japan
| | - Katsuhiro Ichikawa
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, Ishikawa, 920-0942, Japan.
| | - Hiroki Kawashima
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, Ishikawa, 920-0942, Japan
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Selles M, van Osch JAC, Maas M, Boomsma MF, Wellenberg RHH. Advances in metal artifact reduction in CT images: A review of traditional and novel metal artifact reduction techniques. Eur J Radiol 2024; 170:111276. [PMID: 38142571 DOI: 10.1016/j.ejrad.2023.111276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/14/2023] [Accepted: 12/18/2023] [Indexed: 12/26/2023]
Abstract
Metal artifacts degrade CT image quality, hampering clinical assessment. Numerous metal artifact reduction methods are available to improve the image quality of CT images with metal implants. In this review, an overview of traditional methods is provided including the modification of acquisition and reconstruction parameters, projection-based metal artifact reduction techniques (MAR), dual energy CT (DECT) and the combination of these techniques. Furthermore, the additional value and challenges of novel metal artifact reduction techniques that have been introduced over the past years are discussed such as photon counting CT (PCCT) and deep learning based metal artifact reduction techniques.
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Affiliation(s)
- Mark Selles
- Department of Radiology, Isala, 8025 AB Zwolle, the Netherlands; Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, 1105 AZ Amsterdam, the Netherlands; Amsterdam Movement Sciences, 1081 BT Amsterdam, the Netherlands.
| | | | - Mario Maas
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, 1105 AZ Amsterdam, the Netherlands; Amsterdam Movement Sciences, 1081 BT Amsterdam, the Netherlands
| | | | - Ruud H H Wellenberg
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, 1105 AZ Amsterdam, the Netherlands; Amsterdam Movement Sciences, 1081 BT Amsterdam, the Netherlands
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Nemoto H, Saito M, Suzuki T, Suzuki H, Sano N, Mochizuki Z, Mochizuki K, Ueda K, Komiyama T, Marino K, Aoki S, Oguri M, Takahashi H, Onishi H. Evaluation of computed tomography metal artifact and CyberKnife fiducial recognition for novel size fiducial markers. J Appl Clin Med Phys 2023; 24:e14142. [PMID: 37672211 PMCID: PMC10691645 DOI: 10.1002/acm2.14142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 06/28/2023] [Accepted: 08/19/2023] [Indexed: 09/07/2023] Open
Abstract
PURPOSE This study aimed to compare fiducial markers used in CyberKnife treatment in terms of metal artifact intensity observed in CT images and fiducial recognition in the CyberKnife system affected by patient body thickness and type of marker. METHODS Five markers, ACCULOC 0.9 mm × 3 mm, Ball type Gold Anchor (GA) 0.28 mm × 10 mm, 0.28 mm × 20 mm, and novel size GA 0.4 mm × 10 mm, 0.4 mm × 20 mm were evaluated. To evaluate metal artifacts of CT images, two types of CT images of water-equivalent gels with each marker were acquired using Aquilion LB CT scanner, one applied SEMAR (SEMAR-on) and the other did not apply this technique (SEMAR-off). The evaluation metric of artifact intensity (MSD ) which represents a variation of CT values were compared for each marker. Next, 5, 15, and 20 cm thickness of Tough Water (TW) was placed on the gel under the condition of overlapping the vertebral phantom in the Target Locating System, and the live image of each marker was acquired to compare fiducial recognition. RESULTS The mean MSD of SEMAR-off was 78.80, 74.50, 97.25, 83.29, and 149.64 HU for ACCULOC, GA0.28 mm × 10 mm, 20 mm, and 0.40 mm × 10 mm, 20 mm, respectively. In the same manner, that of SEMAR-on was 23.52, 20.26, 26.76, 24.89, and 33.96 HU, respectively. Fiducial recognition decreased in the order of 5, 15, and 20 cm thickness, and GA 0.4 × 20 mm showed the best recognition at thickness of 20 cm TW. CONCLUSIONS We demonstrated the potential to reduce metal artifacts in the CT image to the same level for all the markers we evaluated by applying SEMAR. Additionally, the fiducial recognition of each marker may vary depending on the thickness of the patient's body. Particularly, we showed that GA 0.40 × 20 mm may have more optimal recognition for CyberKnife treatment in cases of high bodily thickness in comparison to the other markers.
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Affiliation(s)
- Hikaru Nemoto
- Department of Advanced Biomedical ImagingUniversity of YamanashiYamanashiJapan
- Department of RadiologyUniversity of YamanashiYamanashiJapan
| | - Masahide Saito
- Department of RadiologyUniversity of YamanashiYamanashiJapan
| | | | - Hidekazu Suzuki
- Department of RadiologyUniversity of YamanashiYamanashiJapan
| | - Naoki Sano
- Department of RadiologyUniversity of YamanashiYamanashiJapan
| | | | - Koji Mochizuki
- Kasugai CyberKnife Rehabilitation HospitalYamanashiJapan
| | - Koji Ueda
- Department of RadiologyUniversity of YamanashiYamanashiJapan
| | | | - Kan Marino
- Department of RadiologyUniversity of YamanashiYamanashiJapan
| | - Shinichi Aoki
- Department of RadiologyUniversity of YamanashiYamanashiJapan
| | - Mitsuhiko Oguri
- Department of RadiologyShizuoka General HospitalShizuokaJapan
| | | | - Hiroshi Onishi
- Department of RadiologyUniversity of YamanashiYamanashiJapan
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Popp D, Sinzinger AX, Decker JA, Braun F, Bette S, Risch F, Haerting M, Garthe T, Scheurig-Muenkler C, Kroencke TJ, Schwarz F. Spectral metal artifact reduction after posterior spinal fixation in photon-counting detector CT datasets. Eur J Radiol 2023; 165:110946. [PMID: 37399668 DOI: 10.1016/j.ejrad.2023.110946] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/12/2023] [Accepted: 06/19/2023] [Indexed: 07/05/2023]
Abstract
PURPOSE To investigate the usefulness of virtual monoenergetic image (VMI) reconstructions derived from scans on a novel photon-counting detector CT (PCD-CT) for artifact reduction in patients after posterior spinal fixation. METHODS This retrospective cohort study included 23 patients status post posterior spinal fixation. Subjects were scanned on a novel PCD-CT (NAEOTOM Alpha, Siemens Healthineers, Erlangen, Germany) as part of routine clinical care. 14 sets of VMI reconstructions were derived in 10 keV increments for the interval 60-190 keV. The mean and the standard deviation (SD) of CT-values in 12 defined locations around a pair of pedicle screws on one vertebral level and the SD of homogenous fat were measured and used to calculate an artifact index (AIx). RESULTS Averaged over all regions, the lowest AIx was observed at VMI levels of 110 keV (32.5 (27.8-37.9)) which was significantly different from those of VMIs ≤ 90 keV (p < 0.001) or ≥160 keV (p < 0.015), respectively. Overall AIx values increased in both lower- and higher-keV levels. Regarding individual locations, either a monotonous AIx-decrease for increasing keV values or an AIx-minimum in intermediate-keV levels (100-140 keV) was found. In locations adjacent to larger metal parts, the increase of AIx values at the high-end of the keV spectrum was mainly explained by a reappearance of streak artifacts. CONCLUSION Our findings suggest that 110 keV is the optimal VMI setting for overall artifact suppression. In specific anatomical regions, however, slight adjustments towards higher-keV levels may provide better results.
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Affiliation(s)
- Daniel Popp
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany.
| | - Andrea X Sinzinger
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany.
| | - Josua A Decker
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany.
| | - Franziska Braun
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany.
| | - Stefanie Bette
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany.
| | - Franka Risch
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany.
| | - Mark Haerting
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany.
| | - Tarik Garthe
- Department of Trauma, Orthopedics, Plastic and Hand Surgery, University Hospital Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany.
| | - Christian Scheurig-Muenkler
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany.
| | - Thomas J Kroencke
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany.
| | - Florian Schwarz
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany; Institute for Radiology, DONAUISAR Hospital Deggendorf-Dingolfing-Landau, Perlasberger Str. 41, 94469 Deggendorf, Germany; Medical Faculty, Ludwig Maximilian University Munich, Bavariaring 19, 80336 Munich, Germany.
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Dunning CAS, Rajendran K, Inoue A, Rajiah P, Weber N, Fletcher JG, McCollough CH, Leng S. Optimal Virtual Monoenergetic Photon Energy (keV) for Photon-Counting-Detector Computed Tomography Angiography. J Comput Assist Tomogr 2023; 47:569-575. [PMID: 36790898 PMCID: PMC10349687 DOI: 10.1097/rct.0000000000001450] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
OBJECTIVE This study aimed to determine the optimal photon energy for virtual monoenergetic images (VMI) in computed tomography angiography (CTA) using photon-counting-detector (PCD) CT. METHODS Under institutional review board approval, 10 patients (abdominal, n = 4; lower extremity, n = 3; head and neck, n = 3) were scanned on an investigational PCD-CT (Count Plus, Siemens Healthcare) at 120 or 140 kV. All images were iteratively reconstructed with Bv48 kernel and 2-mm slice thickness. Axial and coronal VMI maximum-intensity projections were created in the range 40 to 65 keV (5-keV steps). Contrast-to-noise ratio (CNR) was calculated for major arteries in each VMI series. Two radiologists blindly ranked each VMI series for overall image quality and visualization of small vessels and pathology. The median and SD of scores for each photon energy were calculated. In addition, readers identified any VMIs that distinguished itself from others in terms of vessel/pathology visualization or artifacts. RESULTS Mean iodine CNR was highest in 40-keV VMIs for all evaluated arteries. Across readers, the 50-keV VMI had the highest combined score (2.00 ± 1.11). Among different body parts, the 45-keV VMI was ranked highest for the head-and-neck (1.75 ± 0.68) and lower extremity (2.00 ± 1.41) CTA. Meanwhile, 50- and 55-keV VMIs were ranked highest for abdominal (2.50 ± 1.35 and 2.50 ± 1.56) CTA. The 40-keV VMI received the highest score for iodine visualization in vessels, and the 65-keV VMI for reduced metal/calcium-blooming artifacts. CONCLUSIONS Quantitatively, VMIs at 40 keV had the highest CNR in major arterial vasculature using PCD-CTA. Based on radiologists' preference, the 45- and 50-keV VMIs were optimal for small body parts (eg, head and neck and lower extremity) and large body parts (eg, abdomen), respectively.
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Affiliation(s)
| | | | | | | | | | | | | | - Shuai Leng
- Department of Radiology, Mayo Clinic, Rochester, MN
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Chang CH, Wu HN, Hsu CH, Lin HH. Virtual monochromatic imaging with projection-based material decomposition algorithm for metal artifacts reduction in photon-counting detector computed tomography. PLoS One 2023; 18:e0282900. [PMID: 36913430 PMCID: PMC10010526 DOI: 10.1371/journal.pone.0282900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 02/25/2023] [Indexed: 03/14/2023] Open
Abstract
Metal artifacts present a major challenge to computed tomography (CT) because they reduce the image quality in medical diagnosis and treatment. Several metal artifact reduction (MAR) methods have been proposed to address this issue in previous studies. This study aimed to synthesize a virtual monochromatic image for MAR in CT images using projection-based material decomposition (MD) algorithms. We developed a spectral micro-CT prototype system equipped with a photon-counting detector (PCD) and PCD-CT imaging simulator to assess the performances of different MAR methods. Two projection-based MD algorithms were implemented and evaluated for their MAR performances in CT images and compared with conventional sinogram inpainting MAR methods. Different parts of digital 4D-extended cardiac torso (XCAT) phantoms with metal implants were designed to simulate various real scenarios. A homemade metal artifact evaluation (MAE) phantom was used to evaluate the MAR performance in experiments. The simulated results of the XCAT phantom indicated that the projection-based virtual monochromatic CT (VMCT) images provided better image quality than the conventional MAR images without blurring the normal tissues at the position of the metal artifacts. Various quantitative indicators support this conclusion. Additionally, the experimental results of the MAE phantom reveal that projection-based VMCT images can avoid image distortion caused by metal artifacts, unlike conventional MAR methods. In regards to the projection-based VMCT images, the simulated and experimental results demonstrated that using the linear maximum likelihood estimators with an error correction look-up table algorithm yielded better MAR performance compared to that obtained using a polynomial algorithm. Furthermore, projection-based VMCT images can not only reduce metal artifacts effectively but also simultaneously prevents object blurring at the metal artifact position and image distortion of the metal implants. Hence, the CT image quality can be further improved to increase the abilities for both preoperative and postoperative assessment of metal implants.
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Affiliation(s)
- Chia-Hao Chang
- Health Physics Division, Institute of Nuclear Energy Research, Atomic Energy Council, Taoyuan, Taiwan
- Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, Hsinchu, Taiwan
| | - Hsiang-Ning Wu
- Health Physics Division, Institute of Nuclear Energy Research, Atomic Energy Council, Taoyuan, Taiwan
| | - Ching-Han Hsu
- Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, Hsinchu, Taiwan
| | - Hsin-Hon Lin
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan, Taiwan
- Department of Nuclear Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
- Institute for Radiological Research, Chang Gung University/Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Metal implants on abdominal CT: does split-filter dual-energy CT provide additional value over iterative metal artifact reduction? Abdom Radiol (NY) 2023; 48:424-435. [PMID: 36180598 PMCID: PMC9849167 DOI: 10.1007/s00261-022-03682-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 09/09/2022] [Accepted: 09/09/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE To assess image quality and metal artifact reduction in split-filter dual-energy CT (sfDECT) of the abdomen with hip or spinal implants using virtual monoenergetic images (VMI) and iterative metal artifact reduction algorithm (iMAR). METHODS 102 portal-venous abdominal sfDECTs of patients with hip (n = 71) or spinal implants (n = 31) were included in this study. Images were reconstructed as 120kVp-equivalent images (Mixed) and VMI (40-190 keV), with and without iMAR. Quantitative artifact and image noise was measured using 12 different ROIs. Subjective image quality was rated by two readers using a five-point Likert-scale in six categories, including overall image quality and vascular contrast. RESULTS Lowest quantitative artifact in both hip and spinal implants was measured in VMI190keV-iMAR. However, it was not significantly lower than in MixediMAR (for all ROIs, p = 1.00), which were rated best for overall image quality (hip: 1.00 [IQR: 1.00-2.00], spine: 3.00 [IQR:2.00-3.00]). VMI50keV-iMAR was rated best for vascular contrast (hip: 1.00 [IQR: 1.00-2.00], spine: 2.00 [IQR: 1.00-2.00]), which was significantly better than Mixed (both, p < 0.001). VMI50keV-iMAR provided superior overall image quality compared to Mixed for hip (1.00 vs 2.00, p < 0.001) and similar diagnostic image quality for spinal implants (2.00 vs 2.00, p = 0.51). CONCLUSION For abdominal sfDECT with hip or spinal implants MixediMAR images should be used. High keV VMI do not further improve image quality. IMAR allows the use of low keV images (VMI50keV) to improve vascular contrast, compared to Mixed images.
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Kawasaki T, Kikuchi T, Otani K, Mitsuno Y, Yamao Y, Sawamoto N, Takahashi R, Miyamoto S. Intraoperative cone-beam CT with metal artifact reduction for assessment of the electrode position and the intracranial structures during deep brain stimulation procedure. Acta Neurochir (Wien) 2022; 164:2309-2316. [PMID: 35851925 DOI: 10.1007/s00701-022-05313-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 07/08/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND In deep brain stimulation (DBS) for Parkinson's disease (PD), the clinical outcome largely depends on the appropriate position of the electrode implanted in the targeted structure. In intraoperative cone-beam computed tomography (CT) performed for the evaluation of the electrode position, the metal artifact induced by the implanted electrode can prevent the precise localization of the electrode. Metal artifact reduction (MAR) techniques have been recently developed that can dramatically improve the visualization of objects by reducing metal artifacts after performing cone-beam CT. Hence, in this case series, we attempted to clarify the usefulness and accuracy of intraoperative cone-beam CT with MAR (intraCBCTwM) by comparing with both intraoperative cone-beam CT without MAR (intraCBCTwoM) and conventional postoperative CT (post-CT) for the assessment of the implanted electrode position and the intracranial structures during DBS procedures. METHODS Between November 2019 and December 2020, 10 patients with PD who underwent DBS at our institution were recruited, and the images of 9 patients (bilateral: n = 8, unilateral: n = 1) were analyzed. The artifact index (AI) in intraCBCTwM or intraCBCTwoM, and conventional post-CT were retrospectively assessed using the standard deviation of the region-of-interest around the implanted electrodes and background noise. Additionally, the Euclidean distances gap of electrode tip based on post-CT in each fusion image was compared between intraCBCTwM and intraCBCTwoM. RESULTS The AI was significantly lower in intraCBCTwM than in intraCBCTwoM (P < 0.01). The mean Euclidean distance between the tip of the electrode in intraCBCTwM and in post-CT was significantly shorter compared to that in intraCBCTwoM (P < 0.05). CONCLUSIONS The results reported here suggest that intraCBCTwM is a more useful and accurate method than intraCBCTwoM to assess the implanted electrode position and intracranial structures during DBS.
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Affiliation(s)
- Toshinari Kawasaki
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, 54 Shogoinn Kawahara-cho, Sakyo-ku, Kyoto, Kyoto, 606-8507, Japan.,Department of Neurosurgery, Otsu City Hospital, Shiga, Japan
| | - Takayuki Kikuchi
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, 54 Shogoinn Kawahara-cho, Sakyo-ku, Kyoto, Kyoto, 606-8507, Japan.
| | | | - Yuto Mitsuno
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, 54 Shogoinn Kawahara-cho, Sakyo-ku, Kyoto, Kyoto, 606-8507, Japan
| | - Yukihiro Yamao
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, 54 Shogoinn Kawahara-cho, Sakyo-ku, Kyoto, Kyoto, 606-8507, Japan
| | - Nobukatsu Sawamoto
- Department of Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ryosuke Takahashi
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Susumu Miyamoto
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, 54 Shogoinn Kawahara-cho, Sakyo-ku, Kyoto, Kyoto, 606-8507, Japan
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11
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Tran NA, Sodickson AD, Gupta R, Potter CA. Clinical applications of dual-energy computed tomography in neuroradiology. Semin Ultrasound CT MR 2022; 43:280-292. [PMID: 35738814 DOI: 10.1053/j.sult.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Dual-energy computed tomography (DECT) has developed into a robust set of techniques with increasingly validated clinical applications in neuroradiology. We review some of the most common applications in neuroimaging along with demonstrative case examples that showcase the use of this technology in intracranial hemorrhage, stroke imaging, trauma imaging, artifact reduction, and tumor characterization.
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Affiliation(s)
- Ngoc-Anh Tran
- Department of Radiology, Brigham and Women's Hospital, Boston, MA.
| | - Aaron D Sodickson
- Division of Emergency Medicine, Department of Radiology, Brigham and Women's Hospital, Boston, MA
| | - Rajiv Gupta
- Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Christopher A Potter
- Division of Emergency Medicine, Department of Radiology, Brigham and Women's Hospital, Boston, MA; Division of Neuroradiology, Department of Radiology, Brigham and Women's Hospital, Boston, MA
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12
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Zhao X, Chao W, Shan Y, Li J, Zhao C, Zhang M, Lu J. Comparison of Image Quality and Radiation Dose Between Single-Energy and Dual-Energy Images for the Brain With Stereotactic Frames on Dual-Energy Cerebral CT. FRONTIERS IN RADIOLOGY 2022; 2:899100. [PMID: 37492654 PMCID: PMC10364999 DOI: 10.3389/fradi.2022.899100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 05/10/2022] [Indexed: 07/27/2023]
Abstract
Background Preoperative stereotactic planning of deep brain stimulation (DBS) using computed tomography (CT) imaging in patients with Parkinson's disease (PD) is of clinical interest. However, frame-induced metal artifacts are common in clinical practice, which can be challenging for neurosurgeons to visualize brain structures. Objectives To evaluate the image quality and radiation exposure of patients with stereotactic frame brain CT acquired using a dual-source CT (DSCT) system in single- and dual-energy modes. Materials and Methods We included 60 consecutive patients with Parkinson's disease (PD) and randomized them into two groups. CT images of the brain were performed using DSCT (Group A, an 80/Sn150 kVp dual-energy mode; Group B, a 120 kVp single-energy mode). One set of single-energy images (120 kVp) and 10 sets of virtual monochromatic images (50-140 keV) were obtained. Subjective image analysis of overall image quality was performed using a five-point Likert scale. For objective image quality evaluation, CT values, image noise, signal-to-noise ratio (SNR), and contrast-to-noise (CNR) were calculated. The radiation dose was recorded for each patient. Results The mean effective radiation dose was reduced in the dual-energy mode (1.73 mSv ± 0.45 mSv) compared to the single-energy mode (3.16 mSv ± 0.64 mSv) (p < 0.001). Image noise was reduced by 46-52% for 120-140 keV VMI compared to 120 kVp images (both p < 0.01). CT values were higher at 100-140 keV than at 120 kVp images. At 120-140 keV, CT values of brain tissue showed significant differences at the level of the most severe metal artifacts (all p < 0.05). SNR was also higher in the dual-energy mode 90-140 keV compared to 120 kVp images, showing a significant difference between the two groups at 120-140 keV (all p < 0.01). The CNR was significantly better in Group A for 60-140 keV VMI compared to Group B (both p < 0.001). The highest subjective image scores were found in the 120 keV images, while 110-140 keV images had significantly higher scores than 120 kVp images (all p < 0.05). Conclusion DSCT images using dual-energy modes provide better objective and subjective image quality for patients with PD at lower radiation doses compared to single-energy modes and facilitate brain tissue visualization with stereotactic frame DBS procedures.
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Affiliation(s)
- Xiaojing Zhao
- Department of Radiology & Nuclear Medicine, XuanWu Hospital of Capital Medical University, Beijing, China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Wang Chao
- Department of Radiology & Nuclear Medicine, XuanWu Hospital of Capital Medical University, Beijing, China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Yi Shan
- Department of Radiology & Nuclear Medicine, XuanWu Hospital of Capital Medical University, Beijing, China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Jingkai Li
- Department of Radiology & Nuclear Medicine, XuanWu Hospital of Capital Medical University, Beijing, China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Cheng Zhao
- Department of Radiology & Nuclear Medicine, XuanWu Hospital of Capital Medical University, Beijing, China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Miao Zhang
- Department of Radiology & Nuclear Medicine, XuanWu Hospital of Capital Medical University, Beijing, China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Jie Lu
- Department of Radiology & Nuclear Medicine, XuanWu Hospital of Capital Medical University, Beijing, China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
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13
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Kawauchi S, Chida K, Hamada Y, Tsuruta W. Lens dose reduction with a bismuth shield in neuro cone-beam computed tomography: an investigation on optimum shield device placement conditions. Radiol Phys Technol 2021; 15:25-36. [PMID: 34796447 DOI: 10.1007/s12194-021-00644-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 11/26/2022]
Abstract
This study aimed to determine the placement distance, number, and position of the bismuth shield for developing a lens protective device for cone-beam computed tomography (CBCT). To determine the dose reduction rate, the lens doses were measured using an anthropomorphic head phantom and a real-time dosimeter. The image quality assessment was determined by analyzing the change in the pixel value, caused by the bismuth shield, and the artifact index was calculated from the pixel value and image noise within various regions of interest in the head phantom. When the distance between the bismuth shield and the subject was increased, the image quality deteriorated less, but there was also a decrease in the lens dose reduction rate. Upon changing the number of bismuth shields from 1-ply to 2-ply, the dose reduction rate increased; however, there was a decrease in the image quality. Additionally, placing the bismuth shield outside of the subject improved the dose reduction rate without deteriorating the image quality. The optimum placement conditions of the bismuth shield were concluded as follows: positioned outside, placed 10 mm from the surface of the subject, and used a 1-ply bismuth shield. When these placement conditions were used, the lens dose reduction rate was 26.9 ± 0.36% (right-left average) for the "bismuth shield: separate". The protective device developed in this study will contribute to radiation dose reduction in CBCT scans.
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Affiliation(s)
- Satoru Kawauchi
- Department of Radiology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan.
- Department of Radiological Technology, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba-ku, Sendai, Miyagi, 980-8575, Japan.
- Okinaka Memorial Institute for Medical Research, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan.
| | - Koichi Chida
- Department of Radiological Technology, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Yusuke Hamada
- Department of Radiology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Wataro Tsuruta
- Department of Endovascular Neurosurgery, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
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14
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van Ommen F, Kauw F, Bennink E, Heit JJ, Wolman DN, Dankbaar JW, de Jong HWAM, Wintermark M. Image Quality of Virtual Monochromatic Reconstructions of Noncontrast CT on a Dual-Source CT Scanner in Adult Patients. Acad Radiol 2021; 28:e323-e330. [PMID: 32616420 DOI: 10.1016/j.acra.2020.05.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/13/2020] [Accepted: 05/30/2020] [Indexed: 12/26/2022]
Abstract
RATIONALE AND OBJECTIVES To evaluate the image quality of virtual monochromatic images (VMI) reconstructed from dual-energy dual-source noncontrast head CT with different reconstruction kernels. MATERIALS AND METHODS Twenty-five consecutive adult patients underwent noncontrast dual-energy CT. VMI were retrospectively reconstructed at 5-keV increments from 40 to 140 keV using quantitative and head kernels. CT-number, noise levels (SD), signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) in the gray and white matter and artifacts using the posterior fossa artifact index (PFAI) were evaluated. RESULTS CT-number increased with decreasing VMI energy levels, and SD was lowest at 85 keV. SNR was maximized at 80 keV and 85 keV for the head and quantitative kernels, respectively. CNR was maximum at 40 keV; PFAI was lowest at 90 (head kernel) and 100 (quantitative kernel) keV. Optimal VMI image quality was significantly better than conventional CT. CONCLUSION Optimal image quality of VMI energies can improve brain parenchymal image quality compared to conventional CT but are reconstruction kernel dependent and depend on indication for performing noncontrast CT.
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Affiliation(s)
- Fasco van Ommen
- Department of Neuroradiology, Stanford University, Palo Alto, CA; Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Mail E01.132, P.O. Box 85500, Utrecht 3508GA, the Netherlands; Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - Frans Kauw
- Department of Neuroradiology, Stanford University, Palo Alto, CA; Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Mail E01.132, P.O. Box 85500, Utrecht 3508GA, the Netherlands
| | - Edwin Bennink
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Mail E01.132, P.O. Box 85500, Utrecht 3508GA, the Netherlands; Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jeremy J Heit
- Department of Neuroradiology, Stanford University, Palo Alto, CA
| | - Dylan N Wolman
- Department of Neuroradiology, Stanford University, Palo Alto, CA
| | - Jan Willem Dankbaar
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Mail E01.132, P.O. Box 85500, Utrecht 3508GA, the Netherlands
| | - Hugo W A M de Jong
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Mail E01.132, P.O. Box 85500, Utrecht 3508GA, the Netherlands; Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Max Wintermark
- Department of Neuroradiology, Stanford University, Palo Alto, CA
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15
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Exploring the best monochromatic energy level in dual energy spectral imaging for coronary stents after percutaneous coronary intervention. Sci Rep 2021; 11:17576. [PMID: 34475491 PMCID: PMC8413443 DOI: 10.1038/s41598-021-97035-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 08/17/2021] [Indexed: 11/27/2022] Open
Abstract
In this study, the optimal monochromatic energy level in dual-energy spectral CT required for imaging coronary stents after percutaneous coronary intervention (PCI) was explored. Thirty-five consecutive patients after PCI were examined using the dual-energy spectral CT imaging mode. The original images were reconstructed at 40–140 keV (10-keV interval) monochromatic levels. The in-stent and out-stent CT values at each monochromatic level were measured to calculate the signal-to-noise ratio(SNR) and contrast-to-noise ratio (CNR) for the vessel and the CT value difference between the in-stent and out-stent lumen (dCT (in–out)), which reflects the artificial CT number increase due to the beam hardening effect caused by the stents. The subjective image quality of the stent and in-stent vessel was evaluated by two radiologists using a 5-point scale. With the increase in energy level, the CT value, SNR, CNR, and dCT (in–out) all decreased. At 80 keV, the mean CT value in-stent reached (345.24 ± 93.43) HU and dCT (in–out) started plateauing. In addition, the subjective image quality of the stents and vessels peaked at 80 keV. The 80 keV monochromatic images are optimal for imaging cardiac patients with stents after PCI, balancing the enhancement and SNR and CNR in the vessels while minimizing the beam hardening artifacts caused by the stents.
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16
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Puvanasunthararajah S, Fontanarosa D, Wille M, Camps SM. The application of metal artifact reduction methods on computed tomography scans for radiotherapy applications: A literature review. J Appl Clin Med Phys 2021; 22:198-223. [PMID: 33938608 PMCID: PMC8200502 DOI: 10.1002/acm2.13255] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/21/2021] [Accepted: 03/30/2021] [Indexed: 12/22/2022] Open
Abstract
Metal artifact reduction (MAR) methods are used to reduce artifacts from metals or metal components in computed tomography (CT). In radiotherapy (RT), CT is the most used imaging modality for planning, whose quality is often affected by metal artifacts. The aim of this study is to systematically review the impact of MAR methods on CT Hounsfield Unit values, contouring of regions of interest, and dose calculation for RT applications. This systematic review is performed in accordance with the PRISMA guidelines; the PubMed and Web of Science databases were searched using the main keywords "metal artifact reduction", "computed tomography" and "radiotherapy". A total of 382 publications were identified, of which 40 (including one review article) met the inclusion criteria and were included in this review. The selected publications (except for the review article) were grouped into two main categories: commercial MAR methods and research-based MAR methods. Conclusion: The application of MAR methods on CT scans can improve treatment planning quality in RT. However, none of the investigated or proposed MAR methods was completely satisfactory for RT applications because of limitations such as the introduction of other errors (e.g., other artifacts) or image quality degradation (e.g., blurring), and further research is still necessary to overcome these challenges.
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Affiliation(s)
- Sathyathas Puvanasunthararajah
- School of Clinical SciencesQueensland University of TechnologyBrisbaneQLDAustralia
- Centre for Biomedical TechnologiesQueensland University of TechnologyBrisbaneQLDAustralia
| | - Davide Fontanarosa
- School of Clinical SciencesQueensland University of TechnologyBrisbaneQLDAustralia
- Centre for Biomedical TechnologiesQueensland University of TechnologyBrisbaneQLDAustralia
| | - Marie‐Luise Wille
- Centre for Biomedical TechnologiesQueensland University of TechnologyBrisbaneQLDAustralia
- School of MechanicalMedical & Process EngineeringFaculty of EngineeringQueensland University of TechnologyBrisbaneQLDAustralia
- ARC ITTC for Multiscale 3D Imaging, Modelling, and ManufacturingQueensland University of TechnologyBrisbaneQLDAustralia
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Radioprotection of eye lens using protective material in neuro cone-beam computed tomography: Estimation of dose reduction rate and image quality. Phys Med 2021; 82:192-199. [PMID: 33647602 DOI: 10.1016/j.ejmp.2021.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 01/02/2021] [Accepted: 02/07/2021] [Indexed: 11/22/2022] Open
Abstract
PURPOSE In cerebral angiography, for diagnosis and interventional neuroradiology, cone-beam computed tomography (CBCT) scan is frequently performed for evaluating brain parenchyma, cerebral hemorrhage, and cerebral infarction. However, the patient's eye lens is more frequently exposed to excessive doses in these scans than in the previous angiography and interventional neuroradiology (INR) procedures. Hence, radioprotection for the lenses is needed. This study selects the most suitable eye lens protection material for CBCT from among nine materials by evaluating the dose reduction rate and image quality. METHODS To determine the dose reduction rate, the lens doses were measured using an anthropomorphic head phantom and a real-time dosimeter. For image quality assessment, the artifact index was calculated based on the pixel value and image noise within various regions of interest in a water phantom. RESULTS The protective materials exhibited dose reduction; however, streak artifacts were observed near the materials. The dose reduction rate and the degree of the artifact varied significantly depending on the protective material. The dose reduction rates were 14.6%, 14.2%, and 26.0% when bismuth shield: normal (bismuth shield in the shape of an eye mask), bismuth shield: separate (two separate bismuth shields), and lead goggles were used, respectively. The "separate" bismuth shield was found to be effective in dose reduction without lowering the image quality. CONCLUSION We found that bismuth shields and lead goggles are suitable protective devices for the optimal reduction of lens doses.
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Gupta A, Obmann VC, Jordan M, Lennartz S, Obmann MM, Große Hokamp N, Zopfs D, Pennig L, Fürtjes G, Ramaiya N, Gilkeson R, Laukamp KR. CT artifacts after contrast media injection in chest imaging: evaluation of post-processing algorithms, virtual monoenergetic images and their combination for artifact reduction. Quant Imaging Med Surg 2021; 11:226-239. [PMID: 33392024 DOI: 10.21037/qims-20-435] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background After injection into a brachial vein, high contrast media concentration in axillary and subclavian veins can cause artifacts that impair diagnostic utility. This study assessed artifact reduction by artifact-reduction-algorithms (ARA) and virtual-monoenergetic-images (VMI), as well as their combination (VMIARA) compared to conventional CT-images (CI). Methods Forty-six spectral-detector-CT (SDCT) examinations of patients that received ARA-reconstructions due to perivenous-artifacts were included in this retrospective study. CI, ARA, VMI, and VMIARA (range: 70-200 keV) were reconstructed. Objective analysis was performed with ROI-based assessment of mean and standard deviation of attenuation (HU) in hypo- and hyperdense artifacts and impaired muscle and arteries as well as artifact-free reference-tissue. Extent of artifact reduction, assessment of surrounding soft tissue and vessels, and appearance of new artifacts were rated visually by two radiologists. Results Hypo- and hyperdense artifacts showed significant improvement as evidenced by decreasing attenuation differences between artifact impaired and artifact-free reference tissue in ARA, VMI ≥80 keV, and VMIARA between 70-200 keV (e.g., CI/ARA/VMI100keV/VMIARA100keV: hypodense artifacts, (-)264.8±150.9/(-)87.1±78.9/(-)48.6±64.6/9.9±63.9 HU; P<0.001); hyperdense artifacts, 164.2±51.1/82.1±73.2/7.9±34.7/(-)17.3±50.7 HU; P<0.001). Artifacts impairing surrounding muscle and arteries were also reduced by all three approaches. In visual assessment, ARA, VMI ≥100 keV, and VMIARA between 70-200 keV also showed significant artifact reduction and improved assessment; however, for assessment of arteries improvement was not significant using ARA alone. New artifacts were reported, particularly at higher keV-values. Conclusions In presence of perivenous-artifacts, ARA, VMI and their combination allow for significant artifact reduction; however, their combination and VMI as a standalone approach yielded best results and should therefore be used, if available.
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Affiliation(s)
- Amit Gupta
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,Department of Radiology, Case Western Reserve University, Cleveland, OH, USA
| | - Verena Carola Obmann
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,Department of Radiology, Case Western Reserve University, Cleveland, OH, USA.,Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Michelle Jordan
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,Department of Radiology, Case Western Reserve University, Cleveland, OH, USA
| | - Simon Lennartz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Markus Michael Obmann
- Clinic of Radiology and Nuclear Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Nils Große Hokamp
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,Department of Radiology, Case Western Reserve University, Cleveland, OH, USA.,Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - David Zopfs
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Lenhard Pennig
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Gina Fürtjes
- Center for Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Nikhil Ramaiya
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,Department of Radiology, Case Western Reserve University, Cleveland, OH, USA
| | - Robert Gilkeson
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,Department of Radiology, Case Western Reserve University, Cleveland, OH, USA
| | - Kai Roman Laukamp
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,Department of Radiology, Case Western Reserve University, Cleveland, OH, USA.,Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Ishikawa T, Suzuki S, Harashima S, Fukui R, Kaiume M, Katada Y. Metal artifacts reduction in computed tomography: A phantom study to compare the effectiveness of metal artifact reduction algorithm, model-based iterative reconstruction, and virtual monochromatic imaging. Medicine (Baltimore) 2020; 99:e23692. [PMID: 33327359 PMCID: PMC7738054 DOI: 10.1097/md.0000000000023692] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The purpose of this study was to compare the effectiveness of a metal artifact reduction algorithm (MAR), model-based iterative reconstruction (MBIR), and virtual monochromatic imaging (VMI) for reducing metal artifacts in CT imaging.A phantom study was performed for quantitatively evaluating the dark bands and fine streak artifacts generated by unilateral hip prostheses. Images were obtained by conventional scanning at 120 kilovolt peak, and reconstructed using filtered back projection, MAR, and MBIR. Furthermore, virtual monochromatic images (VMIs) at 70 kilo-electron volts (keV) and 140 keV with/without use of MAR were obtained by dual-energy CT. The extents and mean CT values of the dark bands and the differences in the standard deviations and location parameters of the fine streak artifacts evaluated by the Gumbel method in the images obtained by each of the methods were statistically compared by analyses of variance.Significant reduction of the extent of the dark bands was observed in the images reconstructed using MAR than in those not reconstructed using MAR (all, P < .01). Images obtained by VMI at 70 keV and 140 keV with use of MAR showed significantly increased mean CT values of the dark bands as compared to those obtained by reconstructions without use of MAR (all, <.01). Significant reduction of the difference in the standard deviations used to evaluate fine streak artifacts was observed in each of the image sets obtained with VMI at 140 keV with/without MAR and conventional CT with MBIR as compared to the images obtained using other methods (all, P < .05), except between VMI at 140 keV without MAR and conventional CT with MAR. The location parameter to evaluate fine streak artifacts was significantly reduced in CT images obtained using MBIR and in images obtained by VMI at 140 keV with/without MAR as compared to those obtained using other reconstruction methods (all, P < .01).In our present study, MAR appeared to be the most effective reconstruction method for reducing dark bands in CT images, and MBIR and VMI at 140 keV appeared to the most effective for reducing streak artifacts.
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Washio H, Ohira S, Funama Y, Morimoto M, Wada K, Yagi M, Shimamoto H, Koike Y, Ueda Y, Karino T, Inui S, Nitta Y, Miyazaki M, Teshima T. Metal artifact reduction using iterative CBCT reconstruction algorithm for head and neck radiation therapy: A phantom and clinical study. Eur J Radiol 2020; 132:109293. [DOI: 10.1016/j.ejrad.2020.109293] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 08/26/2020] [Accepted: 09/16/2020] [Indexed: 10/23/2022]
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21
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Performance of single-energy metal artifact reduction in cardiac computed tomography: A clinical and phantom study. J Cardiovasc Comput Tomogr 2020; 14:510-515. [DOI: 10.1016/j.jcct.2020.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 04/01/2020] [Accepted: 04/13/2020] [Indexed: 12/11/2022]
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Barreto I, Pepin E, Davis I, Dean C, Massini T, Rees J, Olguin C, Quails N, Correa N, Rill L, Arreola M. Comparison of metal artifact reduction using single-energy CT and dual-energy CT with various metallic implants in cadavers. Eur J Radiol 2020; 133:109357. [PMID: 33126172 DOI: 10.1016/j.ejrad.2020.109357] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 09/15/2020] [Accepted: 10/12/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVES The purpose of this study was to compare the effectiveness of metal artifact reduction using Single Energy Metal Artifact Reduction (SEMAR) and Dual Energy CT (DECT). MATERIALS AND METHODS Six cadavers containing metal implants in the head, neck, abdomen, pelvis, and extremities were scanned with Standard, SEMAR, and DECT protocols on a 320-slice CT scanner. Four specialized radiologists blinded to acquisition methods rated severity of metal artifacts, visualization of anatomic structures, diagnostic interpretation, and image preference with a 5-point grading scale. RESULTS Scores were significantly better for SEMAR than Standard images in the hip, knee, pelvis, abdomen, and maxillofacial scans (3.25 ± 0.88 versus 2.14 ± 0.93, p < 0.001). However, new reconstruction artifacts developed in SEMAR images that were not present in Standard images. Scores for severity of metal artifacts and visualization of smooth structures were significantly better for DECT than Standard images in the cervical spine (3.50±0.50 versus 2.0±0.58, p < 0.001) and was preferred over Standard images by one radiologist. In all other cases, radiologists preferred the Standard image over the DECT image due to increased image noise and reduced low-contrast resolution with DECT. In all cases, SEMAR was preferred over Standard and DECT images. CONCLUSION SEMAR was more effective at reducing metal artifacts than DECT. Radiologists should be aware of new artifacts and review both the original and SEMAR images. When the anatomy or implant is relatively small, DECT may be superior to SEMAR without additional artifacts. However, radiologist should be aware of a reduction in soft tissue contrast.
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Affiliation(s)
- Izabella Barreto
- Department of Radiology, College of Medicine, University of Florida, PO Box 100374, Gainesville, FL 32610-0374, United States.
| | - Eric Pepin
- Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, Texas 75390, United States.
| | - Ivan Davis
- Department of Radiology, College of Medicine, University of Florida, PO Box 100374, Gainesville, FL 32610-0374, United States.
| | - Cooper Dean
- Department of Radiology, College of Medicine, University of Florida, PO Box 100374, Gainesville, FL 32610-0374, United States.
| | - Tara Massini
- Department of Radiology, College of Medicine, University of Florida, PO Box 100374, Gainesville, FL 32610-0374, United States.
| | - John Rees
- Department of Radiology, College of Medicine, University of Florida, PO Box 100374, Gainesville, FL 32610-0374, United States.
| | - Catherine Olguin
- Department of Radiology, College of Medicine, University of Florida, PO Box 100374, Gainesville, FL 32610-0374, United States.
| | - Nathan Quails
- Department of Radiology, Ohio State University Wexner Medical Center, 395 W 12th Ave 4th Fl, Columbus, OH 43210, United States.
| | - Nathalie Correa
- Department of Radiology, College of Medicine, University of Florida, PO Box 100374, Gainesville, FL 32610-0374, United States.
| | - Lynn Rill
- Department of Radiology, College of Medicine, University of Florida, PO Box 100374, Gainesville, FL 32610-0374, United States.
| | - Manuel Arreola
- Department of Radiology, College of Medicine, University of Florida, PO Box 100374, Gainesville, FL 32610-0374, United States.
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Koike Y, Anetai Y, Takegawa H, Ohira S, Nakamura S, Tanigawa N. Deep learning-based metal artifact reduction using cycle-consistent adversarial network for intensity-modulated head and neck radiation therapy treatment planning. Phys Med 2020; 78:8-14. [DOI: 10.1016/j.ejmp.2020.08.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 08/17/2020] [Accepted: 08/18/2020] [Indexed: 01/27/2023] Open
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Wang G, Wang Z, Jin Z. A Novel Metallic Artifact Reduction Technique When Using a Computed Tomography-Guided Percutaneous Metallic Antenna to Ablate Malignant Pulmonary Nodules: A Qualitative and Quantitative Assessment. Med Sci Monit 2020; 26:e923541. [PMID: 32525133 PMCID: PMC7304313 DOI: 10.12659/msm.923541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Metallic microwave ablation (MWA) antenna-related artifacts are usually created in conventional CT images, and these artifacts can influence the effect of ablation. The aim of this study was to evaluate a new type of metal artifact reduction (MAR+) technique in CT-guided MWA for lung cancer. MATERIAL AND METHODS This retrospective study enrolled 30 lung cancer patients who received CT-guided MWA treatment from December 2017 to April 2018. Images after microwave antenna insertion into the tumor were reconstructed by the filter back projection (group A) and MAR+ reconstruction (group B). The CT values and standard deviations of the regions of interest (ROIs) on the chosen image were recorded, including the most significantly hypodense artifact (ROI₁), hyperdense artifacts (ROI₂), and chest muscles of the same layer (ROI₃). The metal artifact indexes based on ROI₁ and ROI₂ (AI₁, AI₂) and the overall metal artifact index (AI) were calculated. Subjective image quality was graded on a five-point scale (1=worst, 5=excellent). RESULTS The AI₁ (74.14±76.32), AI₂ (13.75±19.02) and AI (54.12±54.82) of group B were lower than those of group A [(153.33±89.04), (30.63±26.42), (112.00±63.10), respectively] (P<0.001 for all). Both radiologists reported that the subjective image value of group B was significantly higher than that of group A (P<0.001). The subjective image quality scores evaluated by 2 observers showed excellent consistency (ICC=0.829). CONCLUSIONS The MAR+ imaging reconstruction significantly reduced metal artifacts, which helps radiologists to clearly observe the relationship between the ablation antenna and the lesion.
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Affiliation(s)
- Guorong Wang
- Department of Radiology, Peking Union Medical College Hospital, Beijing, China (mainland)
| | - Zhiwei Wang
- Department of Radiology, Peking Union Medical College Hospital, Beijing, China (mainland)
| | - Zhengyu Jin
- Department of Radiology, Peking Union Medical College Hospital, Beijing, China (mainland)
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25
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Große Hokamp N, Eck B, Siedek F, Pinto Dos Santos D, Holz JA, Maintz D, Haneder S. Quantification of metal artifacts in computed tomography: methodological considerations. Quant Imaging Med Surg 2020; 10:1033-1044. [PMID: 32489927 DOI: 10.21037/qims.2020.04.03] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Numerous methods for artifact quantification in computed tomography (CT) imaging have been suggested. This study evaluated their utility with regards to correspondence with visual artifact perception and reproducibility. Two titanium rods (5 and 10 mm) were examined with 25 different scanning- and image-reconstruction parameters resulting in different types and extents of artifacts. Four radiologists evaluated every image against each other using an in-house developed software. Rating was repeated two times (2,400 comparisons = 2 times × 4 readers × 300 comparisons). Rankings were combined to obtain a reference ranking. Proposed approaches for artifact quantification include manual measurement of attenuation, standard deviation and noise and sophisticated algorithm-based approaches within the image- and frequency-domain. Two radiologists conducted manual measurements twice while the aforementioned algorithms were implemented within the Matlab-Environment allowing for automated image analysis. The reference ranking was compared to all aforementioned methods for artifact quantification to identify suited approaches. Besides visual analysis, Kappa-statistics and intraclass correlation coefficients (ICC) were used. Intra- and Inter-reader agreements of visual artifact perception were excellent (ICC 0.85-0.92). No quantitative method was able to represent the exact ranking of visually perceived artifacts; however, ICC for manual measurements were low (ICC 0.25-0.97). The method that showed best correspondence and reproducibility used a Fourier-transformed linear ROI and lower-end frequency bins. Automated measurements of artifact extent should be preferred over manual measurements as the latter show a limited reproducibility. One method that allows for automated quantification of such artefacts is made available as an electronic supplement.
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Affiliation(s)
- Nils Große Hokamp
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Department of Radiology, Case Western Reserve University, Cleveland, OH, USA.,Department of Radiology, University Hospitals Medical Center, Cleveland, OH, USA
| | - Brendan Eck
- Department of Radiology, Case Western Reserve University, Cleveland, OH, USA
| | - Florian Siedek
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Daniel Pinto Dos Santos
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Jasmin A Holz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - David Maintz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Stefan Haneder
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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26
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Laukamp KR, Große Hokamp N, Alabar O, Obmann VC, Lennartz S, Zopfs D, Gilkeson R, Ramaiya N, Gupta A. Metal artifacts from sternal wires: evaluation of virtual monoenergetic images from spectral-detector CT for artifact reduction. Clin Imaging 2020; 60:249-256. [DOI: 10.1016/j.clinimag.2019.12.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 12/22/2019] [Accepted: 12/27/2019] [Indexed: 10/25/2022]
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Do TD, Heim J, Melzig C, Vollherbst DF, Kauczor HU, Skornitzke S, Sommer CM. Virtual monochromatic spectral imaging versus linearly blended dual-energy and single-energy imaging during CT-guided biopsy needle positioning: Optimization of keV settings and impact on image quality. PLoS One 2020; 15:e0228578. [PMID: 32040496 PMCID: PMC7010258 DOI: 10.1371/journal.pone.0228578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 01/17/2020] [Indexed: 01/08/2023] Open
Abstract
Objectives To compare image quality and metal artifact reduction between virtual monochromatic spectral imaging (VMSI), linearly blended dual-energy (DE) and single-energy (SE) images, each with and without dedicated iterative metal artifact reduction (iMAR) for CT-guided biopsy. Materials and methods A biopsy trocar was positioned in the liver of six pigs. DE (Sn140/100kVp) and SE (120kVp/200mAs) acquisitions were performed with equivalent dose. From dual-energy datasets DE Q30-3 images and VMSI between 40–180 keV in steps of 20 keV were generated. From SE datasets I30-3 images were reconstructed. All images were reconstructed with and without iMAR. Objective image quality was analyzed applying density measurements at standardized positions (e.g. trocar tip and liver parenchyma adjacent to the trocar tip) and semi-automated threshold based segmentation. Subjective image quality was performed using semi-quantitative scores. Analyses were performed by two observers. Results At the trocar tip quantitative image analysis revealed significant difference in CT numbers between reconstructions with iMAR compared to reconstructions without iMAR for VMSI at lower keV levels (80 and 100 keV; p = 0.03) and DE (p = 0.03). For liver parenchyma CT numbers were significantly higher in VMSI at high keV compared to low keV (p≤0.01). VMSI at high keV also showed higher CT numbers compared to DE and SE images, though not the level of statistical significance. The best signal-to-noise ratio for VMSI was at 80 keV and comparable to DE and SE. Noise was lowest at 80 keV and lower than in DE and SE. Subjective image quality was best with VMSI at 80 keV regardless of the application of iMAR. iMAR significantly improved image quality at levels of 140 keV and 160 keV. Interreader-agreement was good for quantitative and qualitative analysis. Conclusion iMAR improved image quality in all settings. VMSI with iMAR provided metal artifact reduction and better image quality at 80 keV and thus could improve the accurate positioning in CT-guided needle biopsy. In comparison, DE imaging did not improve image quality compared to SE.
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Affiliation(s)
- T. D. Do
- Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
- * E-mail:
| | - J. Heim
- Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - C. Melzig
- Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - D. F. Vollherbst
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | - H. U. Kauczor
- Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - S. Skornitzke
- Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - C. M. Sommer
- Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
- Clinic for Diagnostic and Interventional Radiology, Klinikum Stuttgart, Stuttgart, Germany
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Nagayama Y, Tanoue S, Oda S, Sakabe D, Emoto T, Kidoh M, Uetani H, Sasao A, Nakaura T, Ikeda O, Yamada K, Yamashita Y. Metal Artifact Reduction in Head CT Performed for Patients with Deep Brain Stimulation Devices: Effectiveness of a Single-Energy Metal Artifact Reduction Algorithm. AJNR Am J Neuroradiol 2020; 41:231-237. [PMID: 31879332 DOI: 10.3174/ajnr.a6375] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 11/15/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Deep brain stimulation electrodes induce massive artifacts on CT images, deteriorating the diagnostic value of examinations. We aimed to investigate the usefulness and potential limitations of a single-energy metal artifact reduction algorithm in head CT performed in patients with implanted deep brain stimulation devices. MATERIALS AND METHODS Thirty-four patients with deep brain stimulation (bilateral, n = 28) who underwent head CT on a 320-detector row scanner and whose images were reconstructed with and without single-energy metal artifact reduction at the examinations were retrospectively included. The severity of artifacts around electrodes was assessed objectively using SDs and an artifact index. Two radiologists subjectively evaluated the severity of artifacts from electrodes, the visibility of electrode localization and surrounding structures, and overall diagnostic confidence on 4-point scales. Background image quality (GM-WM contrast and image noise) was subjectively and objectively assessed. The presence and location of artifacts newly produced by single-energy metal artifact reduction were analyzed. RESULTS Single-energy metal artifact reduction provided lower objective and subjective metal artifacts and improved visualization of electrode localization and surrounding structures and diagnostic confidence compared with non-single-energy metal artifact reduction images, with statistical significance (all, P < .01). No significant differences were observed in GM-WM contrast and image noise (all, P ≥ .11). The new artifacts from single-energy metal artifact reduction were prominently observed in patients with bilateral deep brain stimulation at high convexity, possibly induced by deep brain stimulation leads placed under the parietal scalp. CONCLUSIONS Single-energy metal artifact reduction substantially reduces the metal artifacts from deep brain stimulation electrodes and improves the visibility of intracranial structures without affecting background image quality. However, non-single-energy metal artifact reduction images should be simultaneously reviewed to accurately assess the entire intracranial area, particularly in patients with bilateral deep brain stimulation.
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Affiliation(s)
- Y Nagayama
- From the Department of Diagnostic Radiology (Y.N., S.O., M.K., H.U., A.S., T.N., O.I., Y.Y.)
| | - S Tanoue
- Diagnostic Radiology (S.T.), Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - S Oda
- From the Department of Diagnostic Radiology (Y.N., S.O., M.K., H.U., A.S., T.N., O.I., Y.Y.)
| | - D Sakabe
- Department of Central Radiology (D.S., T.E.), Kumamoto University Hospital, Kumamoto, Japan
| | - T Emoto
- Department of Central Radiology (D.S., T.E.), Kumamoto University Hospital, Kumamoto, Japan
| | - M Kidoh
- From the Department of Diagnostic Radiology (Y.N., S.O., M.K., H.U., A.S., T.N., O.I., Y.Y.)
| | - H Uetani
- From the Department of Diagnostic Radiology (Y.N., S.O., M.K., H.U., A.S., T.N., O.I., Y.Y.)
| | - A Sasao
- From the Department of Diagnostic Radiology (Y.N., S.O., M.K., H.U., A.S., T.N., O.I., Y.Y.)
| | - T Nakaura
- From the Department of Diagnostic Radiology (Y.N., S.O., M.K., H.U., A.S., T.N., O.I., Y.Y.)
| | - O Ikeda
- From the Department of Diagnostic Radiology (Y.N., S.O., M.K., H.U., A.S., T.N., O.I., Y.Y.)
| | - K Yamada
- Graduate School of Medical Sciences, and Departments of Neurosurgery (K.Y.)
| | - Y Yamashita
- From the Department of Diagnostic Radiology (Y.N., S.O., M.K., H.U., A.S., T.N., O.I., Y.Y.)
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Nair JR, Burrows C, Jerome S, Ribeiro L, Larrazabal R, Gupta R, Yu E. Dual energy CT: a step ahead in brain and spine imaging. Br J Radiol 2020; 93:20190872. [PMID: 31944834 DOI: 10.1259/bjr.20190872] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE The purpose of this pictorial essay is to illustrate the utility of dual energy CT as an adjunct or alternative to routine single energy CT (SECT) scan of the brain and spine in emergency neuroradiology practice. CONCLUSION Dual energy CT can be used as a problem-solving tool in brain and spine imaging. It enables one to make a confident and accurate diagnosis for a variety of clinical conditions thereby impacting patient management.
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Affiliation(s)
- Jaykumar Raghavan Nair
- McMaster University Faculty of Health Sciences, Department of Radiology, Hamilton, ON, Canada.,McGill University Health Centre, Department of Radiology, Montreal, QC, Canada.,University of Calgary, Department of Radiology, Calgary, AB, Canada
| | - Claire Burrows
- McMaster University Faculty of Health Sciences, Department of Radiology, Hamilton, ON, Canada
| | - Sue Jerome
- McMaster University Faculty of Health Sciences, Department of Radiology, Hamilton, ON, Canada
| | - Luciana Ribeiro
- McMaster University Faculty of Health Sciences, Department of Radiology, Hamilton, ON, Canada
| | - Ramiro Larrazabal
- McMaster University Faculty of Health Sciences, Department of Radiology, Hamilton, ON, Canada
| | - Rajiv Gupta
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Eugene Yu
- Department of Radiology, University of Toronto, Toronto, ON, Canada
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30
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Dual-Energy and Iterative Metal Artifact Reduction for Reducing Artifacts Due to Metallic Hardware: A Loosening Hip Phantom Study. AJR Am J Roentgenol 2019; 212:1106-1111. [PMID: 30835522 DOI: 10.2214/ajr.18.20413] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. The purpose of this study was to compare the value of iterative metal artifact reduction (IMAR) with that of dual-energy CT (DECT) and filtered back projection (FBP) CT protocols for reducing metal artifacts and for facilitating visualization of the acetabular cortex in a loosening hip phantom model. MATERIALS AND METHODS. CT scans were obtained with conventional FBP and dual-source CT for two types of hip phantom. For the quantitative study, attenuation was measured by placement of ROIs in the phantoms around the metallic hardware. The differences between mean attenuation in each ROI and the actual attenuation were compared among the three CT protocols. For the qualitative study, the visibility of the acetabular cortex in the artificial loosening area of the total hip arthroplasty model and in the joint space of the bipolar hemiarthroplasty model was evaluated by measurement of the obscured cortical angle. RESULTS. In the quantitative study, attenuation differences in the bipolar hemiarthroplasty model were markedly decreased with IMAR and DECT compared with FBP (p = 0.006-0.007). In the total hip replacement model, attenuation differences were significantly lower with IMAR than with FBP (p < 0.001). In the qualitative study, visibility of the acetabular cortex was markedly improved with IMAR compared with DECT and FBP (p < 0.001) for both hip models. CONCLUSION. CT with IMAR can reduce the distortion caused by metal artifacts more effectively than FBP and DECT can while preserving visibility of the acetabular cortex in both bipolar hemiarthroplasty and total hip arthroplasty phantoms.
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Zeng Y, Deng K, Yang H, Tan Y, Liu J, Geng D, Zhang J. Noise-optimised virtual monoenergetic imaging of dual-energy CT: effect on metal artefact reduction in patients with lumbar internal fixation. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 28:1783-1792. [PMID: 31041597 DOI: 10.1007/s00586-019-05984-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 04/09/2019] [Accepted: 04/19/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the effects of noise-optimised virtual monoenergetic imaging (VMI+) reconstructions on reducing metal artefacts compared to traditional virtual monoenergetic imaging (VMI) and linearly blended (M_0.6) reconstructions in patients with lumbar metal internal fixation in dual-energy CT (DECT). METHODS Forty patients who underwent DECT were evaluated in this retrospective study. Images were reconstructed with M_0.6 and with VMI+ and VMI at 10-keV intervals from 40 keV to 190 keV. Attenuation and noise were measured in the hyperdense artefacts, hypodense artefacts, spinal canal, abdominal aorta (AA), and inferior vena cava (IVC). An artefact index (AI) was calculated. A subjective evaluation of the metal-bone interface, surrounding soft tissue, spinal canal, AA, and IVC was conducted. RESULTS The AI values for the hypodense artefacts, spinal canal, and IVC were lowest in the 130 keV VMI+ series, for the hyperdense artefacts in the 120 keV VMI+ series, and for the AA in the 190 keV VMI+ series. Except for the hypodense artefacts, the AI values were lower compared to the M_0.6 images and all the VMI series (all p < 0.05). The subjective image quality was highest at 130 keV VMI+ for the metal-bone interface, surrounding soft tissue, AA, and IVC, and at 120 keV VMI+ for the spinal canal. Except for the AA, these rating scores were higher compared to the M_0.6 images and the entire VMI series (all p < 0.05). CONCLUSIONS DECT with high-keV VMI+ efficiently reduces metal artefacts and shows superior image quality in patients with lumbar internal fixation. These slides can be retrieved from Electronic Supplementary Material.
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Affiliation(s)
- Yanwei Zeng
- Department of Radiology, Huashan Hospital, Fudan University, No.12 Wulumuqi Road (Middle), Shanghai, 200040, China
- Institute of Functional and Molecular Medical Imaging, Fudan University, No.12 Wulumuqi Road (Middle), Shanghai, 200040, China
| | - Kai Deng
- Department of Radiology, Second Xiangya Hospital, Central South University, Changsha, 410011, China
| | - Haitao Yang
- Department of Radiology, Second Xiangya Hospital, Central South University, Changsha, 410011, China
| | - Yi Tan
- Department of Radiology, Second Xiangya Hospital, Central South University, Changsha, 410011, China
| | - Jun Liu
- Department of Radiology, Second Xiangya Hospital, Central South University, Changsha, 410011, China.
| | - Daoying Geng
- Department of Radiology, Huashan Hospital, Fudan University, No.12 Wulumuqi Road (Middle), Shanghai, 200040, China
- Institute of Functional and Molecular Medical Imaging, Fudan University, No.12 Wulumuqi Road (Middle), Shanghai, 200040, China
| | - Jun Zhang
- Department of Radiology, Huashan Hospital, Fudan University, No.12 Wulumuqi Road (Middle), Shanghai, 200040, China.
- Institute of Functional and Molecular Medical Imaging, Fudan University, No.12 Wulumuqi Road (Middle), Shanghai, 200040, China.
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Metal artifacts in patients with large dental implants and bridges: combination of metal artifact reduction algorithms and virtual monoenergetic images provides an approach to handle even strongest artifacts. Eur Radiol 2019; 29:4228-4238. [PMID: 30649598 DOI: 10.1007/s00330-018-5928-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 11/06/2018] [Accepted: 11/28/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVES This study compares reduction of strong metal artifacts from large dental implants/bridges using spectral detector CT-derived virtual monoenergetic images (VMI), metal artifact reduction algorithms/reconstructions (MAR), and a combination of both methods (VMIMAR) to conventional CT images (CI). METHODS Forty-one spectral detector CT (SDCT) datasets of patients that obtained additional MAR reconstructions due to strongest artifacts from large oral implants were included. CI, VMI, MAR, and VMIMAR ranging from 70 to 200 keV (10 keV increment) were reconstructed. Objective image analyses were performed ROI-based by measurement of attenuation (HU) and standard deviation in most pronounced hypo-/hyperdense artifacts as well as artifact impaired soft tissue (mouth floor/soft palate). Extent of artifact reduction, diagnostic assessment of soft tissue, and appearance of new artifacts were rated visually by two radiologists. RESULTS The hypo-/hyperattenuating artifacts showed an increase and decrease of HU values in MAR and VMIMAR (CI/MAR/VMIMAR-200keV: - 369.8 ± 239.6/- 37.3 ± 109.6/- 46.2 ± 71.0 HU, p < 0.001 and 274.8 ± 170.2/51.3 ± 150.8/36.6 ± 56.0, p < 0.001, respectively). Higher keV values in hyperdense artifacts allowed for additional artifact reduction; however, this trend was not significant. Artifacts in soft tissue were reduced significantly by MAR and VMIMAR. Visually, high-keV VMI, MAR, and VMIMAR reduced artifacts and improved diagnostic assessment of soft tissue. Overcorrection/new artifacts were reported that mostly did not hamper diagnostic assessment. Overall interrater agreement was excellent (ICC = 0.85). CONCLUSIONS In the presence of strong artifacts due to large oral implants, MAR is a powerful mean for artifact reduction. For hyperdense artifacts, MAR should be supplemented by VMI ranging from 140 to 200 keV. This combination yields optimal artifact reduction and improves the diagnostic image assessment in imaging of the head and neck. KEY POINTS • Large oral implants can cause strong artifacts. • MAR is a powerful tool for artifact reduction considering such strong artifacts. • Hyperdense artifact reduction is supplemented by VMI of 140-200 keV from SDCT.
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Metal Artifact Reduction in Routine Chest and Abdominal Examinations Using Virtual Monoenergetic Images From Spectral Detector Computed Tomography. J Comput Assist Tomogr 2019; 43:713-717. [DOI: 10.1097/rct.0000000000000901] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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34
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Clinical Assessment of Metal Artifact Reduction Methods in Dual-Energy CT Examinations of Instrumented Spines. AJR Am J Roentgenol 2018; 212:395-401. [PMID: 30667317 DOI: 10.2214/ajr.18.19757] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the performance of three metal artifact reduction methods in dual-energy CT (DECT) examinations of instrumented spines. MATERIALS AND METHODS Twenty patients with instrumented spines who underwent spine DECT were retrospectively identified. All scans were obtained on a dual-source 128-MDCT scanner. In addition to the original DE mixed images, DECT images were reconstructed using an iterative metal artifact reconstruction algorithm (DE iMAR), virtual monochromatic imaging (VMI) algorithm (DE Mono+), and a combination of the two algorithms DE iMAR and DE Mono+, which we refer to here as "DE iMAR Mono+." The four image series were anonymized and randomized for a reader study. Four experienced neuroradiologists rated the images in terms of artifact scores of four anatomic regions and overall image quality scores in both bone and soft-tissue display window settings. In addition, a quantitative analysis was performed to assess the performance of the three metal artifact reduction methods. RESULTS There were statistically significant differences in the artifact scores and overall image quality scores among the four methods (both, p < 0.001). DE iMAR Mono+ showed the best artifact scores and quality scores (all, p < 0.001). The intraclass correlation coefficient for the overall image quality score was 0.779 using the bone display window and 0.892 using the soft-tissue display window (both, p < 0.001). In addition, DE iMAR Mono+ reduced the artifacts by the greatest amount in the quantitative analysis. CONCLUSION The method that used DE iMAR Mono+ showed the best performance of spine metal artifact reduction using DECT data. These results may be specific to this CT vendor and implant type.
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Zhu L, Chen Y, Yang J, Tao X, Xi Y. Evaluation of the dental spectral cone beam CT for metal artefact reduction. Dentomaxillofac Radiol 2018; 48:20180044. [PMID: 30299983 DOI: 10.1259/dmfr.20180044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES: Metal artefacts are highly common in dental CT images because of the high X-ray attenuation of metallic dental fillings and implants. This study presents an evaluation of the virtual monochromatic imaging for metal artefact reduction by a recently introduced dental spectral cone beam CT, which is the first commercial dental spectral CBCT with flat-panel detector. METHODS: We carried out phantom experiments and clinical trials in this study. In the phantom study, the head phantom with metallic dental fillings and implants of various materials was scanned. Moreover, standard deviation, metal artefact index, and contrast-to-noise ratio were analyzed for fixed region of interest. Patient study included 23 patients with metallic fillings and metal implants. Traditional CT images and virtual monochromatic images were produced in a single scan, ensuring that the comparison can be made within the same patient and same location. Standard deviation and metal artefact index were analyzed for fixed region of interest. RESULTS: The phantom study and patient study showed that the metal artefacts caused by metallic dental fillings are well-suppressed by the virtual monochromatic imaging. Moreover, the improvements in virtual monochromatic imaging in terms of image quality are more pronounced for small dental fillings.. The noise increase in image slices without metallic objects is a side-effect of the virtual monochromatic images. CONCLUSIONS: Virtual monochromatic imaging by spectral cone beam CT reduces the metal artefact and improves the image contrast-to-noise ratio around dental metallic fillings. This kind of imaging would be recommended for patients with dental metallic fillings.
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Affiliation(s)
- Ling Zhu
- 1 Department of Radiology, Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University , Shanghai , China
| | - Yi Chen
- 2 Imaging research group, UEG Medical Imaging Equipment Co. Ltd. , Shanghai , China
| | - Jie Yang
- 3 Department of Diagnostic Imaging, Division of Oral & Maxillofacial Radiology, Temple University School of Dentistry, Temple University School of Medicine , Philadelphia, PA , USA
| | - Xiaofeng Tao
- 4 Department of Radiology, Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University , Shanghai , China
| | - Yan Xi
- 5 Imaging research group, UEG Medical Imaging Equipment Co. Ltd. , Shanghai , China
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Metal Artifact Reduction in Virtual Monoenergetic Spectral Dual-Energy CT of Patients With Metallic Orthopedic Implants in the Distal Radius. AJR Am J Roentgenol 2018; 211:1083-1091. [PMID: 30240300 DOI: 10.2214/ajr.18.19514] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the image quality of virtual monoenergetic images obtained from dual-layer-detector spectral CT of patients with metallic orthopedic implants of the distal radius. MATERIALS AND METHODS A retrospective analysis was performed between April 2016 and January 2017. Forty-three consecutively registered patients (33 women, 10 men; mean age, 50.7 ± 15.4 years) with metallic implants for distal radius fractures underwent dual-layer-detector spectral CT. Sixteen virtual monoenergetic image sets ranging from 50 to 200 keV were generated from the single slice with the most pronounced low-attenuation artifact from implants. Image quality was quantitatively assessed on the basis of the attenuation of the artifacts and reference tissue, background image noise, and artifact index. Qualitative assessment included degree of artifact, diagnostic image quality of the periimplant bones, and delineation of fracture lines. The Friedman rank sum test and kappa analysis were used for statistical analysis. RESULTS There were statistically significant differences in quantitative and qualitative parameters at different monoenergy levels (all p < 0.001). Artifact index was the lowest at 120 keV. Low-attenuation artifacts in the periimplant regions were least pronounced at 110 keV, and the diagnostic image quality of periimplant bone was best at 130 keV. Fracture lines were well delineated in all cases at 80-110 keV (p < 0.001). CONCLUSION The optimal energy setting for incurring the fewest metallic artifacts and obtaining the best diagnostic image quality from distal radius implants during dual-layer-detector spectral CT is the range of 110-130 keV.
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The Optimal Energy Level of Virtual Monochromatic Images From Spectral CT for Reducing Beam-Hardening Artifacts Due to Contrast Media in the Thorax. AJR Am J Roentgenol 2018; 211:557-563. [DOI: 10.2214/ajr.17.19377] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Abstract
Dual-energy computed tomography (DECT) enables material decomposition and virtual monochromatic images by acquiring 2 different energy X-ray data sets. DECT can detect musculoskeletal pathologic conditions that CT alone cannot, and that would otherwise require MR imaging. In this review, the authors discuss several useful techniques and applications of DECT in musculoskeletal research: virtual monochromatic images, virtual noncalcium images, gout, iodine map, and tendons.
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Affiliation(s)
- Takeshi Fukuda
- Department of Radiology, The Jikei University School of Medicine, 3-19-18, Nishi-Shimbashi, Minato-ku, Tokyo 105-8471, Japan; Department of Radiology, Stony Brook Medicine, HSC Level 4, Room 120, Stony Brook, NY 11794, USA.
| | - Kunihiko Fukuda
- Centre for International Affairs, The Jikei University, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
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Wellenberg RHH, Hakvoort ET, Slump CH, Boomsma MF, Maas M, Streekstra GJ. Metal artifact reduction techniques in musculoskeletal CT-imaging. Eur J Radiol 2018; 107:60-69. [PMID: 30292274 DOI: 10.1016/j.ejrad.2018.08.010] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 07/02/2018] [Accepted: 08/11/2018] [Indexed: 01/02/2023]
Abstract
It is known that metal artifacts can be reduced by modifying standard acquisition and reconstruction, by modifying projection data and/or image data and by using virtual monochromatic imaging extracted from dual-energy CT. In this review we focus on the origin of metal artifacts, technical background of commercially available metal artifact reduction (MAR) algorithms and the value of dual-energy CT and MAR software for different metal hardware in current clinical practice. Virtual monochromatic imaging reduces beam-hardening artifacts, where metal artifact reduction software effectively reduces artifacts caused by extensive photon-starvation. Both techniques have their advantages and disadvantages, and the combination of both techniques is often but not always the best solution regarding metal artifact reduction. Advances in prosthetic imaging are reinforced by advances in prosthetic design. Providing implant specific information prior to scanning is important in order to adjust the metal artifact reduction approach, minimize artifacts and optimize image quality and diagnostic value of CT.
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Affiliation(s)
- R H H Wellenberg
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, location AMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands; Department of Radiology, Isala, Zwolle, The Netherlands.
| | - E T Hakvoort
- Department of Biomedical Engineering and Physics, Amsterdam University Medical Center, location AMC, Amsterdam, The Netherlands.
| | - C H Slump
- MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands.
| | - M F Boomsma
- Department of Radiology, Isala, Zwolle, The Netherlands.
| | - M Maas
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, location AMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.
| | - G J Streekstra
- Department of Biomedical Engineering and Physics, Amsterdam University Medical Center, location AMC, Amsterdam, The Netherlands.
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Yue D, Fan Rong C, Ning C, Liang H, Ai Lian L, Ru Xin W, Ya Hong L. Reduction of metal artifacts from unilateral hip arthroplasty on dual-energy CT with metal artifact reduction software. Acta Radiol 2018; 59:853-860. [PMID: 28899125 DOI: 10.1177/0284185117731475] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The evaluation of hip arthroplasty is a challenge in computed tomography (CT). The virtual monochromatic spectral (VMS) images with metal artifact reduction software (MARs) in spectral CT can reduce the artifacts and improve the image quality. Purpose To evaluate the effects of VMS images and MARs for metal artifact reduction in patients with unilateral hip arthroplasty. Material and Methods Thirty-five patients underwent dual-energy CT. Four sets of VMS images without MARs and four sets of VMS images with MARs were obtained. Artifact index (AI), CT number, and SD value were assessed at the periprosthetic region and the pelvic organs. The scores of two observers for different images and the inter-observer agreement were evaluated. Results The AIs in 120 and 140 keV images were significantly lower than those in 80 and 100 keV images. The AIs of the periprosthetic region in VMS images with MARs were significantly lower than those in VMS images without MARs, while the AIs of pelvic organs were not significantly different. VMS images with MARs improved the accuracy of CT numbers for the periprosthetic region. The inter-observer agreements were good for all the images. VMS images with MARs at 120 and 140 keV had higher subjective scores and could improve the image quality, leading to reliable diagnosis of prosthesis-related problems. Conclusion VMS images with MARs at 120 and 140 keV could significantly reduce the artifacts from hip arthroplasty and improve the image quality at the periprosthetic region but had no obvious advantage for pelvic organs.
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Affiliation(s)
- Dong Yue
- Department of Radiology, Cancer Hospital of China Medical University, LiaoNing Cancer Hospital, LiaoNing, PR China
| | - Cheng Fan Rong
- Department of Radiology, Cancer Hospital of China Medical University, LiaoNing Cancer Hospital, LiaoNing, PR China
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, LiaoNing, PR China
| | - Cai Ning
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, LiaoNing, PR China
| | - Hu Liang
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, LiaoNing, PR China
| | - Liu Ai Lian
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, LiaoNing, PR China
| | - Wang Ru Xin
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, LiaoNing, PR China
| | - Luo Ya Hong
- Department of Radiology, Cancer Hospital of China Medical University, LiaoNing Cancer Hospital, LiaoNing, PR China
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Reduction of Artifacts Caused by Deep Brain Stimulating Electrodes in Cranial Computed Tomography Imaging by Means of Virtual Monoenergetic Images, Metal Artifact Reduction Algorithms, and Their Combination. Invest Radiol 2018; 53:424-431. [DOI: 10.1097/rli.0000000000000460] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Laukamp KR, Lennartz S, Neuhaus VF, Große Hokamp N, Rau R, Le Blanc M, Abdullayev N, Mpotsaris A, Maintz D, Borggrefe J. CT metal artifacts in patients with total hip replacements: for artifact reduction monoenergetic reconstructions and post-processing algorithms are both efficient but not similar. Eur Radiol 2018; 28:4524-4533. [PMID: 29725834 DOI: 10.1007/s00330-018-5414-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 02/22/2018] [Accepted: 02/27/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES 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). METHODS 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. RESULTS 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). CONCLUSIONS 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.
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Affiliation(s)
- Kai Roman Laukamp
- Department of Radiology, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Simon Lennartz
- Department of Radiology, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | | | - Nils Große Hokamp
- Department of Radiology, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Robert Rau
- Department of Radiology, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Markus Le Blanc
- Department of Radiology, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Nuran Abdullayev
- Department of Radiology, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Anastasios Mpotsaris
- Department of Radiology, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - David Maintz
- Department of Radiology, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Jan Borggrefe
- Department of Radiology, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
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Takada K, Ichikawa K, Banno S, Otobe K. [Suggestion of the Relative Artifact Index for Noise-independent Evaluation of the Streak Artifact]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2018; 74:315-325. [PMID: 29681598 DOI: 10.6009/jjrt.2018_jsrt_74.4.315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The aim of this study was to inspect the usefulness of relative artifact index (AIr), which divided artifact index (AI) by standard deviation of the noise image for noise-independent evaluation of the streak artifact in computed tomography images. A water phantom without/with a cylindrical phantom filled with diluted contrast medium was scanned with different tube voltages (100/120/140 kV) and radiation doses (5/10/20 mGy), then images were reconstructed with different kernels (B10/30/50f). AI, location parameter in Gumbel method and AIr were measured in each condition and compared. The higher tube voltage or radiation dose or lower spatial resolution kernel, the lower quantitative values were presented by both AI and Gumbel method. AIr showed quantitative values independent of radiation dose and kernel, and substantial artifact amounts affected only by tube voltage. Our results showed AIr can evaluate quantitative artifact amount independent of image noise.
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Affiliation(s)
- Ken Takada
- Department of Medical Technology, Ogaki Municipal Hospital
| | - Katsuhiro Ichikawa
- Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University
| | - Shinnya Banno
- Department of Medical Technology, Ogaki Municipal Hospital
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Nishitani T, Matsugi K, Kitano T, Yamamoto H, Kaneko M, Yamada S. [Improvement of CT Imaging with a Metal Artifact Reduction Technique for Radiation Treatment Planning-Fundamental Study of Structure Delineation and Dose Calculation]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2018; 74:39-47. [PMID: 29353835 DOI: 10.6009/jjrt.2018_jsrt_74.1.39] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In radiotherapy planning, CT images are widely used to delineate the gross tumor volume (GTV) and the organs at risks (OARs), which allows for the calculation of the dose distribution to each structure. The delineated contours of the GTV and OARs may become inaccurate, and subsequently result in the inaccurate derivation of the dose distribution, if there are metal artifacts present in the CT image. The metal artifact reduction technique, single energy metal artifact reduction (SEMAR), installed on the CT system (Aquilion ONETM Vision Edition, Toshiba Medical Systems Corporation) could potentially reduce metal artifacts. Therefore, we investigated whether SEMAR can improve the accuracy of delineation, and subsequently the dosimetric accuracy, in the treatment planning process. Using an acrylonitrile-butadiene-styrene resin phantom (RT-3000-New, R-Tech. Inc, Tokyo, Japan), titanium bars were inserted on both the left and right sides, and four types of electron density inserts (rods) were separately inserted in the middle. The electron densities of the rods were 0.90, 0.96, 1.07, and 1.09. After CT images were acquired, SEMAR-ON (when applying the SEMAR correction) images were generated. On both SEMAR-ON and SEMAR-OFF (when not applying the SEMAR correction) images, the rod contours were delineated automatically, using a CT value threshold. This threshold was selected so that the area of the automatically delineated contour was 615.4 mm2. The difference in the contour area of SEMAR-ON, SEMAR-OFF, and no metal artifact images were compared using the dice coefficient. When SEMAR was used, the dice coefficient improved by 57.4%. Therefore, SEMAR was considered to be useful in improving the accuracy of GTV and OAR delineation.
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Affiliation(s)
- Takuya Nishitani
- Department of Radiation Oncology, Shiga Medical Center for Adults
| | - Kiyotomo Matsugi
- Department of Radiation Oncology, Shiga Medical Center for Adults
| | - Tetsuya Kitano
- Department of Radiology, Shiga Medical Center for Adults
| | | | | | - Shigeki Yamada
- Department of Radiology, Shiga Medical Center for Adults
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Wellenberg RHH, Donders JCE, Kloen P, Beenen LFM, Kleipool RP, Maas M, Streekstra GJ. Exploring metal artifact reduction using dual-energy CT with pre-metal and post-metal implant cadaver comparison: are implant specific protocols needed? Skeletal Radiol 2018; 47:839-845. [PMID: 28842739 PMCID: PMC5915501 DOI: 10.1007/s00256-017-2750-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 07/26/2017] [Accepted: 08/01/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To quantify and optimize metal artifact reduction using virtual monochromatic dual-energy CT for different metal implants compared to non-metal reference scans. METHODS Dual-energy CT scans of a pair of human cadaver limbs were acquired before and after implanting a titanium tibia plate, a stainless-steel tibia plate and a titanium intramedullary nail respectively. Virtual monochromatic images were analyzed from 70 to 190 keV. Region-of-interest (ROI), used to determine fluctuations and inaccuracies in CT numbers of soft tissues and bone, were placed in muscle, fat, cortical bone and intramedullary tibia canal. RESULTS The stainless-steel implant resulted in more pronounced metal artifacts compared to both titanium implants. CT number inaccuracies in 70 keV reference images were minimized at 130, 180 and 190 keV for the titanium tibia plate, stainless-steel tibia plate and titanium intramedullary nail respectively. Noise, measured as the standard deviation of pixels within a ROI, was minimized at 130, 150 and 140 keV for the titanium tibia plate, stainless-steel tibia plate and titanium intramedullary nail respectively. CONCLUSION Tailoring dual-energy CT protocols using implant specific virtual monochromatic images minimizes fluctuations and inaccuracies in CT numbers in bone and soft tissues compared to non-metal reference scans.
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Affiliation(s)
| | - Johanna C. E. Donders
- Department of Orthopedic Surgery, AMC, Amsterdam, The Netherlands ,Orthopedic Trauma Service, Hospital for Special Surgery, New York, NY USA
| | - Peter Kloen
- Department of Orthopedic Surgery, AMC, Amsterdam, The Netherlands
| | - Ludo F. M. Beenen
- Department of Radiology, AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | | | - Mario Maas
- Department of Radiology, AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Geert J. Streekstra
- Department of Biomedical Engineering and Physics, AMC, Amsterdam, The Netherlands
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Wang T, Ishihara T, Kono A, Yoshida N, Akasaka H, Mukumoto N, Yada R, Ejima Y, Yoshida K, Miyawaki D, Kakutani K, Nishida K, Negi N, Minami T, Aoyama Y, Takahashi S, Sasaki R. Application of dual-energy CT to suppression of metal artefact caused by pedicle screw fixation in radiotherapy: a feasibility study using original phantom. Phys Med Biol 2017; 62:6226-6245. [PMID: 28675378 DOI: 10.1088/1361-6560/aa7d7f] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The objective of the present study was the determination of the potential dosimetric benefits of using metal-artefact-suppressed dual-energy computed tomography (DECT) images for cases involving pedicle screw implants in spinal sites. A heterogeneous spinal phantom was designed for the investigation of the dosimetric effect of the pedicle-screw-related artefacts. The dosimetric comparisons were first performed using a conventional two-directional opposed (AP-PA) plan, and then a volumetric modulated arc therapy (VMAT) plan, which are both used for the treatment of spinal metastases in our institution. The results of Acuros® XB dose-to-medium (Dm) and dose-to-water (Dw) calculations using different imaging options were compared with experimental measurements including the chamber and film dosimetries in the spinal phantom. A dual-energy composition image with a weight factor of -0.2 and a dual-energy monochromatic image (DEMI) with an energy level of 180 keV were found to have superior abilities for artefact suppression. The Dm calculations revealed greater dosimetric effects of the pedicle screw-related artefacts compared to the Dw calculations. The results of conventional single-energy computed tomography showed that, although the pedicle screws were made from low-Z titanium alloy, the metal artefacts still have dosimetric effects, namely, an average (maximum) Dm error of 4.4% (5.6%) inside the spinal cord for a complex VMAT treatment plan. Our findings indicate that metal-artefact suppression using the proposed DECT (DEMI) approach is promising for improving the dosimetric accuracy near the implants and inside the spinal cord (average (maximum) Dm error of 1.1% (2.0%)).
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Affiliation(s)
- Tianyuan Wang
- Division of Radiation Oncology, Kobe University Graduate School of Medicine, 7-5-2 Kusunokicho, Chuouku, Kobe, Hyogo 650-0017, Japan
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Metal artifact reduction by dual-layer computed tomography using virtual monoenergetic images. Eur J Radiol 2017; 93:143-148. [PMID: 28668408 DOI: 10.1016/j.ejrad.2017.05.013] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 05/09/2017] [Accepted: 05/11/2017] [Indexed: 01/27/2023]
Abstract
OBJECTIVE The aim of the study was to investigate the performance and diagnostic value of metal artifact reduction in virtual monoenergetic images generated from dual-layer computed tomography (DLCT). METHODS 35 patients that received a DLCT at the University Hospital Cologne and had an orthopedic implant in the examined region were included in this study. For each DLCT virtual monoenergetic images of different energy levels (64keV, 70keV, 105keV, 140keV, 200keV and an optimized photon energy) were reconstructed and analyzed by three blinded observers. Images were analyzed with regard to subjective criteria (extent of artifacts, diagnostic image quality) and objective criteria (width and density of artifacts). RESULTS 21 patients had implants in the spine, 8 in the pelvis and 6 patients in the extremities. Diagnostic image quality improved significantly at high photon energies from a Likert-score of 4.3 (±0.83) to 2.3 (±1.02) and artifacts decreased significantly from a score of 4.3 (±0.66) to 2.6 (±2.57). The average optimized photon energy was 149.2±39.4keV. The density as well as the width of the most pronounced artifacts decreased from-374.6±251.89HU to -12.5±205.84HU and from 14.5±8.74mm to 6.4±10.76mm, respectively. CONCLUSION Using virtual monoenergetic images valuable improvements of diagnostic image quality can be achieved by reduction of artifacts associated with metal implants. As preset for virtual monoenergetic images, 140keV appear to provide optimal artifact reduction. In 20% of the patients, individually optimized keV can lead to a further improvement of image quality compared to 140keV.
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Kidoh M, Utsunomiya D, Oda S, Nakaura T, Funama Y, Yuki H, Hirata K, Hatemura M, Namimoto T, Yamashita Y. CT venography after knee replacement surgery: comparison of dual-energy CT-based monochromatic imaging and single-energy metal artifact reduction techniques on a 320-row CT scanner. Acta Radiol Open 2017; 6:2058460117693463. [PMID: 28321330 PMCID: PMC5347276 DOI: 10.1177/2058460117693463] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Accepted: 01/17/2017] [Indexed: 11/18/2022] Open
Abstract
Background An optimal metal artifact reduction (MAR) technique is needed for a reliable and accurate image-based diagnosis. Purpose Using a 320-row scanner, we compared the dual-energy computed tomography (CT)-based monochromatic and the single-energy metal artifact reduction (SEMAR) techniques for CT venography (CTV) to identify the better imaging method for diagnosing deep vein thrombosis (DVT) in patients who had undergone knee replacement surgery. Material and Methods Twenty-three consecutive patients with suspected DVT after unilateral knee replacement surgery underwent dual-energy CT (135/80 kVp). Monochromatic images of 35–135 keV were generated; the monochromatic image with the best signal-to-noise ratio (SNR) of the popliteal vein near the metal prosthesis were selected. The projection data of 80 kVp were reconstructed using MAR algorithm. The mean SNR ON MAR and the best SNR ON monochromatic images were compared. Two radiologists evaluated visualization of the metal artifacts on a four-point scale where 1 = extensive artifacts, 2 = strong artifacts, 3 = mild artifacts, and 4 = minimal artifacts. Results The mean SNR was significantly higher on the MAR than the monochromatic images (12.8 ± 4.7 versus 7.7 ± 5.1, P < 0.01) and the visual scores were significantly higher for MAR than monochromatic images (2.6 ± 0.8 versus 1.3 ± 0.4, P < 0.01). Conclusion For CTV after knee replacement surgery, the MAR technique is superior to the monochromatic imaging technique.
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Affiliation(s)
- Masafumi Kidoh
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Daisuke Utsunomiya
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Seitaro Oda
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Takeshi Nakaura
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Yoshinori Funama
- Department of Medical Physics, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Hideaki Yuki
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Kenichiro Hirata
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Masahiro Hatemura
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Tomohiro Namimoto
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Yasuyuki Yamashita
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
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Dual energy CT angiography: pros and cons of dual-energy metal artifact reduction algorithm in patients after endovascular aortic repair. Abdom Radiol (NY) 2017; 42:749-758. [PMID: 27896386 DOI: 10.1007/s00261-016-0973-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To evaluate the value of metal artifact reduction (MAR) post-processing and iodine MD images in fast kV-switching dual-energy computed tomography (DECT) in patients after endovascular aortic repair (EVAR). MATERIALS AND METHODS Twenty-four consecutive EVAR patients (age 76 ± 9 years, 7/24 (29%) with coils, 9/24 (37.5%) with 10 endoleaks) who underwent DECT angiography were included in this HIPAA-compliant, IRB-approved retrospective study. Monochromatic reconstructions included 55, 60, 65, 70, and 75 keV with and without MAR and iodine MD images. Near field, far field, and vessel artifacts were assessed subjectively (1 = none; 5 = severe) and objectively by measuring noise and contrast-to-noise ratio. Visibility of endoleak was evaluated (1 = optimal; 5 = not visible). RESULTS MAR objectively decreased artifacts from EVAR stents in the near field (60.7 ± 25.4 HU vs. 70.1 ± 34.2; p = .002) and subjectively increased near field (3.2 ± 0.9 vs. 2.8 ± 0.6; p < .001), far field (2.2 ± 0.6 vs. 1.6 ± 0.6; p < .001), and vessel (3.1 ± 1.1 vs. 2.5 ± 0.9; p < .001) artifacts. Near-field artifacts from coils were reduced by the MAR objectively (72.4 ± 24.8 vs. 182.7 ± 57.3 HU; p < .001) and subjectively (4.5 ± 0.5 vs. 4.9 ± 0.4; p = .02). CNR of standard reconstructions was optimal at 60 keV (38.3 ± 16.8). Reconstructions without MAR and iodine MD images provided improved endoleak visualization in 6/10 (60%) of cases (median 1 for both) compared to MAR (median 3) (p < 0.001). However, MAR improved visualization in 1/10 (10%) cases due to endoleak location adjacent to a coil. CONCLUSION DECT with MAR reduced artifacts from coils and improved endoleak visualization in 1/10 (10%) cases due to location adjacent to a coil. However, MAR impaired endoleak visualization in 6/10 (60%) cases and should be reviewed combined with 60 keV standard reconstructions and iodine MD images.
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