Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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Value and Clinical Application of Orthopedic Metal Artifact Reduction Algorithm in CT Scans after Orthopedic Metal Implantation

  • Hu, Yi (Department of Radiology, Shengjing Hospital of China Medical University) ;
  • Pan, Shinong (Department of Radiology, Shengjing Hospital of China Medical University) ;
  • Zhao, Xudong (Department of Radiology, Shengjing Hospital of China Medical University) ;
  • Guo, Wenli (Department of Radiology, Shengjing Hospital of China Medical University) ;
  • He, Ming (Department of Orthopedics, Shengjing Hospital of China Medical University) ;
  • Guo, Qiyong (Department of Radiology, Shengjing Hospital of China Medical University)
  • Received : 2016.01.14
  • Accepted : 2016.12.18
  • Published : 2017.06.01
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Abstract

Objective: To evaluate orthopedic metal artifact reduction algorithm (O-MAR) in CT orthopedic metal artifact reduction at different tube voltages, identify an appropriate low tube voltage for clinical practice, and investigate its clinical application. Materials and Methods: The institutional ethical committee approved all the animal procedures. A stainless-steel plate and four screws were implanted into the femurs of three Japanese white rabbits. Preoperative CT was performed at 120 kVp without O-MAR reconstruction, and postoperative CT was performed at 80-140 kVp with O-MAR. Muscular CT attenuation, artifact index (AI) and signal-to-noise ratio (SNR) were compared between preoperative and postoperative images (unpaired t test), between paired O-MAR and non-O-MAR images (paired Student t test) and among different kVp settings (repeated measures ANOVA). Artifacts' severity, muscular homogeneity, visibility of inter-muscular space and definition of bony structures were subjectively evaluated and compared (Wilcoxon rank-sum test). In the clinical study, 20 patients undertook CT scan at low kVp with O-MAR with informed consent. The diagnostic satisfaction of clinical images was subjectively assessed. Results: Animal experiments showed that the use of O-MAR resulted in accurate CT attenuation, lower AI, better SNR, and higher subjective scores (p < 0.010) at all tube voltages. O-MAR images at 100 kVp had almost the same AI and SNR as non-O-MAR images at 140 kVp. All O-MAR images were scored ${\geq}3$. In addition, 95% of clinical CT images performed at 100 kVp were considered satisfactory. Conclusion: O-MAR can effectively reduce orthopedic metal artifacts at different tube voltages, and facilitates low-tube-voltage CT for patients with orthopedic metal implants.

Keywords

References

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