Comparison of different CT metal artifact reduction strategies for standard titanium and carbon‐fiber reinforced polymer implants in sheep cadavers
Abstract Background CT artifacts induced by orthopedic implants can limit image quality and diagnostic yield. As a number of different strategies to reduce artifact extent exist, the aim of this study was to systematically compare ex vivo the impact of different CT metal artifact reduction (MAR) str...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-02-01
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| Series: | BMC Medical Imaging |
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| Online Access: | https://doi.org/10.1186/s12880-021-00554-y |
| _version_ | 1818875403014504448 |
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| author | Florian A. Huber Kai Sprengel Lydia Müller Laura C. Graf Georg Osterhoff Roman Guggenberger |
| author_facet | Florian A. Huber Kai Sprengel Lydia Müller Laura C. Graf Georg Osterhoff Roman Guggenberger |
| author_sort | Florian A. Huber |
| collection | DOAJ |
| description | Abstract Background CT artifacts induced by orthopedic implants can limit image quality and diagnostic yield. As a number of different strategies to reduce artifact extent exist, the aim of this study was to systematically compare ex vivo the impact of different CT metal artifact reduction (MAR) strategies on spine implants made of either standard titanium or carbon-fiber-reinforced-polyetheretherketone (CFR-PEEK). Methods Spine surgeons fluoroscopically-guided prepared six sheep spine cadavers with pedicle screws and rods of either titanium or CFR-PEEK. Samples were subjected to single- and dual-energy (DE) CT-imaging. Different tube voltages (80, DE mixed, 120 and tin-filtered 150 kVp) at comparable radiation dose and iterative reconstruction versus monoenergetic extrapolation (ME) techniques were compared. Also, the influence of image reconstruction kernels (soft vs. bone tissue) was investigated. Qualitative (Likert scores) and quantitative parameters (attenuation changes induced by implant artifact, implant diameter and image noise) were evaluated by two independent radiologists. Artifact degree of different MAR-strategies and implant materials were compared by multiple ANOVA analysis. Results CFR-PEEK implants induced markedly less artifacts than standard titanium implants (p < .001). This effect was substantially larger than any other tested MAR technique. Reconstruction algorithms had small impact in CFR-PEEK implants and differed significantly in MAR efficiency (p < .001) with best MAR performance for DECT ME 130 keV (bone kernel). Significant differences in image noise between reconstruction kernels were seen (p < .001) with minor impact on artifact degree. Conclusions CFR-PEEK spine implants induce significantly less artifacts than standard titanium compositions with higher MAR efficiency than any alternate scanning or image reconstruction strategy. DECT ME 130 keV image reconstructions showed least metal artifacts. Reconstruction kernels primarily modulate image noise with minor impact on artifact degree. |
| first_indexed | 2024-12-19T13:25:56Z |
| format | Article |
| id | doaj.art-7167691777634ccca72c09d04ab74a59 |
| institution | Directory Open Access Journal |
| issn | 1471-2342 |
| language | English |
| last_indexed | 2024-12-19T13:25:56Z |
| publishDate | 2021-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Medical Imaging |
| spelling | doaj.art-7167691777634ccca72c09d04ab74a592022-12-21T20:19:33ZengBMCBMC Medical Imaging1471-23422021-02-0121111110.1186/s12880-021-00554-yComparison of different CT metal artifact reduction strategies for standard titanium and carbon‐fiber reinforced polymer implants in sheep cadaversFlorian A. Huber0Kai Sprengel1Lydia Müller2Laura C. Graf3Georg Osterhoff4Roman Guggenberger5Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Faculty of Medicine, University of ZurichDepartment of Trauma, University Hospital Zurich, Faculty of Medicine, University of ZurichInstitute of Diagnostic and Interventional Radiology, University Hospital Zurich, Faculty of Medicine, University of ZurichInstitute of Diagnostic and Interventional Radiology, University Hospital Zurich, Faculty of Medicine, University of ZurichDepartment of Trauma, University Hospital Zurich, Faculty of Medicine, University of ZurichInstitute of Diagnostic and Interventional Radiology, University Hospital Zurich, Faculty of Medicine, University of ZurichAbstract Background CT artifacts induced by orthopedic implants can limit image quality and diagnostic yield. As a number of different strategies to reduce artifact extent exist, the aim of this study was to systematically compare ex vivo the impact of different CT metal artifact reduction (MAR) strategies on spine implants made of either standard titanium or carbon-fiber-reinforced-polyetheretherketone (CFR-PEEK). Methods Spine surgeons fluoroscopically-guided prepared six sheep spine cadavers with pedicle screws and rods of either titanium or CFR-PEEK. Samples were subjected to single- and dual-energy (DE) CT-imaging. Different tube voltages (80, DE mixed, 120 and tin-filtered 150 kVp) at comparable radiation dose and iterative reconstruction versus monoenergetic extrapolation (ME) techniques were compared. Also, the influence of image reconstruction kernels (soft vs. bone tissue) was investigated. Qualitative (Likert scores) and quantitative parameters (attenuation changes induced by implant artifact, implant diameter and image noise) were evaluated by two independent radiologists. Artifact degree of different MAR-strategies and implant materials were compared by multiple ANOVA analysis. Results CFR-PEEK implants induced markedly less artifacts than standard titanium implants (p < .001). This effect was substantially larger than any other tested MAR technique. Reconstruction algorithms had small impact in CFR-PEEK implants and differed significantly in MAR efficiency (p < .001) with best MAR performance for DECT ME 130 keV (bone kernel). Significant differences in image noise between reconstruction kernels were seen (p < .001) with minor impact on artifact degree. Conclusions CFR-PEEK spine implants induce significantly less artifacts than standard titanium compositions with higher MAR efficiency than any alternate scanning or image reconstruction strategy. DECT ME 130 keV image reconstructions showed least metal artifacts. Reconstruction kernels primarily modulate image noise with minor impact on artifact degree.https://doi.org/10.1186/s12880-021-00554-yArtifactsPEEKMultidetector computed tomographyImage reconstructionDiagnostic imagingPedicle screws |
| spellingShingle | Florian A. Huber Kai Sprengel Lydia Müller Laura C. Graf Georg Osterhoff Roman Guggenberger Comparison of different CT metal artifact reduction strategies for standard titanium and carbon‐fiber reinforced polymer implants in sheep cadavers BMC Medical Imaging Artifacts PEEK Multidetector computed tomography Image reconstruction Diagnostic imaging Pedicle screws |
| title | Comparison of different CT metal artifact reduction strategies for standard titanium and carbon‐fiber reinforced polymer implants in sheep cadavers |
| title_full | Comparison of different CT metal artifact reduction strategies for standard titanium and carbon‐fiber reinforced polymer implants in sheep cadavers |
| title_fullStr | Comparison of different CT metal artifact reduction strategies for standard titanium and carbon‐fiber reinforced polymer implants in sheep cadavers |
| title_full_unstemmed | Comparison of different CT metal artifact reduction strategies for standard titanium and carbon‐fiber reinforced polymer implants in sheep cadavers |
| title_short | Comparison of different CT metal artifact reduction strategies for standard titanium and carbon‐fiber reinforced polymer implants in sheep cadavers |
| title_sort | comparison of different ct metal artifact reduction strategies for standard titanium and carbon fiber reinforced polymer implants in sheep cadavers |
| topic | Artifacts PEEK Multidetector computed tomography Image reconstruction Diagnostic imaging Pedicle screws |
| url | https://doi.org/10.1186/s12880-021-00554-y |
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