Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
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Comparison of Metal Artifact Reduction Algorithms in Patients with Hip Prostheses: Virtual Monoenergetic Images vs. Orthopedic Metal Artifact Reduction

고관절 인공치환술 환자에서 금속 인공물 감소 방법의 비교: 가상 단일에너지영상 대 금속 인공물 감소기법

  • Hye Jin Yoo (Department of Radiology, Seoul National University Hospital) ;
  • Sung Hwan Hong (Department of Radiology, Seoul National University Hospital) ;
  • Ja-Young Choi (Department of Radiology, Seoul National University Hospital) ;
  • Hee Dong Chae (Department of Radiology, Seoul National University Hospital)
  • 류혜진 (서울대학교병원 영상의학과) ;
  • 홍성환 (서울대학교병원 영상의학과) ;
  • 최자영 (서울대학교병원 영상의학과) ;
  • 채희동 (서울대학교병원 영상의학과)
  • Received : 2021.07.22
  • Accepted : 2021.12.14
  • Published : 2022.11.01
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Abstract

Purpose To assess the usefulness of various metal artifact reduction (MAR) methods in patients with hip prostheses. Materials and Methods This retrospective study included 47 consecutive patients who underwent hip arthroplasty and dual-energy CT. Conventional polyenergetic image (CI), orthopedic-MAR (OMAR), and virtual monoenergetic image (VMI, 50-200 keV) were tested for MAR. Quantitative analysis was performed in seven regions around the prostheses. Qualitative assessments included evaluation of the degree of artifacts and the presence of secondary artifacts. Results The lowest amount of image noise was observed in the O-MAR, followed by the VMI. O-MAR also showed the lowest artifact index, followed by high-keV VMI in the range of 120-200 keV (soft tissue) or 200 keV (bone). O-MAR had the highest contrast-to-noise ratio (CNR) in regions with severe hypodense artifacts, while VMI had the highest CNR in other regions, including the periprosthetic bone. On assessment of the CI of pelvic soft tissues, VMI showed a higher structural similarity than O-MAR. Upon qualitative analysis, metal artifacts were significantly reduced in O-MAR, followed by that in VMI, while secondary artifacts were the most frequently found in the O-MAR (p < 0.001). Conclusion O-MAR is the best technique for severe MAR, but it can generate secondary artifacts. VMI at high keV can be advantageous for evaluating periprosthetic bone.

목적 고관절 인공치환물을 가진 환자에서 여러 가지 금속인공물 감소 효과를 비교하였다. 대상과 방법 이 연구는 고관절 인공치환술과 이중에너지 전산화단층촬영을 시행한 47명 환자에서 시행하였다. 금속에서 발생한 인공물 감소효과는 서로 다른 3개의 영상(고식적 영상, 금속인공물 감소영상, 가상 단일에너지 영상)에서 비교하였다. 이를 위해 인공관절 주변 7곳에서 금속인공물에 대한 정량적 분석과 정성적 분석을 시행하였다. 결과 금속인공물 감소영상에서 가장 낮은 영상잡음과 인공물 지수를 보였고, 다음으로는 가상 단일에너지 영상이었다. 금속인공물 감소영상은 저음영 인공물이 매우 심한 영역에서만 높은 대조도를 보인 반면, 가상 단일에너지 영상은 인공물 주변 골조직과 그 외 영역에서 높은 대조도를 보였다. 연부조직 분석에서도 금속인공물 감소영상이 더 우수함을 보여 주었다. 정성적 분석에서도 금속인공물 감소영상이 가상 단일에너지 영상보다 인공물 감소 효과가 뛰어남을 밝혔지만, 이차적인 인공물 발생도 가장 흔히 발생하였다. 결론 금속인공물 감소영상이 심한 금속인공물감소에 가장 뛰어난 효과를 보였지만 새로운 이차적 인공물을 발생시켰다. 가상 단일에너지 영상은 인공물 주변 골조직 평가에서 우수함을 보였다.

Keywords

Acknowledgement

This study was supported by Seoul National University Hospital Research Fund (800-20180100). The funders had no role in study design, data collection, and analysis, decision to publish, or preparation of the manuscript.

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