Monoenergetic Imaging of Dual-energy CT Reduces Artifacts from Implanted Metal Orthopedic Devices in Patients with Factures

Zhou, Changsheng; Zhao, Yan; Luo, Song; Shi, Hongyuan; Lin, Li; Zheng, Ling; Zhang, Long Jiang; Lu, Guangming

doi:10.1016/j.acra.2011.05.009

Cited by 157 publications

(119 citation statements)

References 18 publications

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“…(17) The image quality and diagnostic value of DECT imaging of orthopaedic hardware were found to be significantly improved, with minimal artefacts, at a highenergy monoenergetic 130 keV setting. (18,19) This was seen in our case, where monoenergetic 130 keV images were superior to average weighted 120 keV images in minimising beam hardening artefacts (not shown). Of note, the monoenergetic 80 keV images better demonstrated contrast insinuation into the implant-cement interface (which confirmed the presence of glenoid component loosening) compared to the monoenergetic 130 keV images also useful in determining the presence of a full-thickness rotator cuff tendon tear (a known complication of anatomic total shoulder arthroplasty), in addition to the finding of glenoid component loosening.…”

Section: A 7bsupporting

confidence: 51%

Clinics in diagnostic imaging (167)

Tan

Aljefri

Elliott

et al. 2016

smedj

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A 59-year-old woman presented with left shoulder pain and stiffness of 12 months' duration. She had previously undergone an anatomic left total shoulder arthroplasty four years ago for avascular necrosis of the humeral head with advanced secondary glenohumeral osteoarthritis. The patient had actively participated in a postoperative rehabilitation programme, with good pain relief and restoration of function of the left shoulder. However, over a period of 12 months prior to the current clinical presentation, the patient began to experience increasing left shoulder pain and stiffness, which limited her activities of daily living. A physical examination revealed significant reduction in motion of the left shoulder, which included limitation of active forward flexion of about 40°. There was also difficulty in initiating shoulder abduction. Radiographic (Fig. 1a) and arthrographic (Fig. 1b) assessments of the left shoulder were performed. These were followed by dual-energy computed tomography (DECT) of the left shoulder, which was performed without intravenous contrast immediately following the left shoulder arthrogram (Figs. 1c & d).What do these images demonstrate? What is the diagnosis?

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Section: A 7bsupporting

confidence: 51%

Clinics in diagnostic imaging (167)

Tan

Aljefri

Elliott

et al. 2016

smedj

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“…Application of an extended CT scale, thin-section collimation, a small FOV, dedicated reconstruction kernels, 2 and an increase of the tube voltage and current are options for reducing these artifacts; however, increasing the tube voltage and current increase patient radiation exposure, and none of these options have been dramatically successful. More elaborate strategies include monoenergetic processing of dual-energy CT data, which works nicely for surgical plates and implants, 11,12 but its effect is limited with dental hardware. Sinogram in-painting methods 8,13,14 and iterative, 15,16 statistical, 17,18 and filtering methods 13,19 have been suggested, but for various reasons, they have not made their way into clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Improved Image Quality in Head and Neck CT Using a 3D Iterative Approach to Reduce Metal Artifact

Wuest

May

Brand

et al. 2015

AJNR Am J Neuroradiol

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“…Dual-energy (DE) CT combines both approaches with the acquisition of image data at two different energy spectra [13] together with the reconstruction of monoenergetic extrapolations [14]. This latter technique of monoenergetic extrapolation has been demonstrated to be effective for increasing the interpretability through reduction of metallic streak artefacts [15,16]. Bamberg et al [15] suggested that high monoenergy reconstructions can be performed at an overall value of 105 keV including various metallic implants in the spine, hip, femur, humerus, radius, ulna and ankle.…”

Section: Introductionmentioning

confidence: 99%

“…However, vendors and material specifications were not known to the authors of that study, and no differences were taken into account among implants and spine levels. Zhou et al [16] recommended an overall setting at 130 keV, but no individual optimisation of the monoenergy values with regard to material and geometry was performed.…”

Section: Introductionmentioning

confidence: 99%

Metallic artefact reduction with monoenergetic dual-energy CT: systematic ex vivo evaluation of posterior spinal fusion implants from various vendors and different spine levels

et al. 2012

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Objectives To evaluate optimal monoenergetic dual-energy computed tomography (DECT) settings for artefact reduction of posterior spinal fusion implants of various vendors and spine levels. Methods Posterior spinal fusion implants of five vendors for cervical, thoracic and lumbar spine were examined ex vivo with single-energy (SE) CT (120 kVp) and DECT (140/100 kVp). Extrapolated monoenergetic DECT images at 64, 69, 88, 105 keV and individually adjusted monoenergy for optimised image quality (OPTkeV) were generated. Two independent radiologists assessed quantitative and qualitative image parameters for each device and spine level. Results Inter-reader agreements of quantitative and qualitative parameters were high (ICC00.81-1.00, κ00.54-0.77). HU values of spinal fusion implants were significantly different among vendors (P<0.001), spine levels (P<0.01) and among SECT, monoenergetic DECT of 64, 69, 88, 105 keV and OPTkeV (P<0.01). Image quality was significantly (P<0.001) different between datasets and improved with higher monoenergies of DECT compared with SECT (V 00.58, P < 0.001). Artefacts decreased significantly (V00.51, P<0.001) at higher monoenergies. OPTkeV values ranged from 123-141 keV. OPTkeV according to vendor and spine level are presented herein. Conclusions Monoenergetic DECT provides significantly better image quality and less metallic artefacts from implants than SECT. Use of individual keV values for vendor and spine level is recommended. Key Points• Artefacts pose problems for CT following posterior spinal fusion implants.• CT images are interpreted better with monoenergetic extrapolation using dual-energy (DE) CT.• DECT extrapolation improves image quality and reduces metallic artefacts over SECT.• There were considerable differences in monoenergy values among vendors and spine levels.• Use of individualised monoenergy values is indicated for different metallic hardware devices.

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Monoenergetic Imaging of Dual-energy CT Reduces Artifacts from Implanted Metal Orthopedic Devices in Patients with Factures

Cited by 157 publications

References 18 publications

Clinics in diagnostic imaging (167)

Clinics in diagnostic imaging (167)

Improved Image Quality in Head and Neck CT Using a 3D Iterative Approach to Reduce Metal Artifact

Metallic artefact reduction with monoenergetic dual-energy CT: systematic ex vivo evaluation of posterior spinal fusion implants from various vendors and different spine levels

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