Top

Insights into Imaging

Published in:

Open Access 01-12-2023 | Original Article

Optimal combination periprosthetic vasculature visualization and metal artifact reduction by spectral computed tomography using virtual monoenergetic images in total hip arthroplasty

Authors: Jie Zhao, Qiang Cheng, Chuan Liu, Qiqi Wang, Yuchan Lv, Ziyi Tang, Yuxi Luo, Haitao Yang

Published in: Insights into Imaging | Issue 1/2023

Abstract

Objectives

To investigate the optimal parameters of spectral CT for preferably visualizing the periprosthetic vasculature and metal artifact reduction (MAR) in total hip arthroplasty (THA).

Methods

A total of 34 THA of 30 patients were retrospectively included. Image reconstructions included conventional image (CI), CI combined with MAR (CI_MAR), and virtual monoenergetic images (VMI) combined with MAR (VMI_MAR) at 50–120 keV. The attenuation and standard deviation of the vessel and artifact, and the width of artifact were measured. Qualitative scoring was evaluated including the vascular contour, the extent of artifact, and overall diagnostic evaluation.

Results

The attenuation, noise of the vessel and artifact, and the width of artifact decreased as the energy level increased (p < 0.001). The downtrend was relatively flat at 80–120 keV, and the vascular attenuation dropped to 200 HU at 90 keV. The qualitative rating of vascular contour was significantly higher at CI_MAR (3.47) and VMI_MAR 60–80 keV (2.82–3.65) compared with CI (2.03) (p ≤ 0.029), and the highest score occurred at 70 and 80 keV (3.65 and 3.56). The score of the extent of artifact was higher at VMI_MAR 80 keV than CI_MAR (3.53 VS 3.12, p = 0.003). The score of the overall diagnostic evaluation was higher at VMI_MAR 70 and 80 keV (3.32 and 3.53, respectively) than CI_MAR (3.12) (p ≤ 0.035).

Conclusion

Eighty kiloelectron volts on VMI_MAR, providing satisfactorily reduced metal artifacts and improved vascular visualization, can be an optimal recommended parameter of spectrum CT for the assessment of periprosthetic vasculature in THA patients.

Critical relevance statement

The metal artifact is gradually reducing with increasing energy level; however, the vascular visualization is worsening. The vascular visualization is terrible above 100 keV, while the vessel is disturbed by artifacts below 70 keV. The best performance is found at 80 keV.

Key points

• VMI_MAR can provide both reduced metal artifacts and improved vascular visualization.

• Eighty kiloelectron volts on VMI_MAR performs best in vascular visualization of total hip arthroplasty patients.

• Energy spectrum CT is recommended for routine use in patients with total hip arthroplasty.

Graphical Abstract

Melvin JS, Karthikeyan T, Cope R, Fehring TK (2014) Early failures in total hip arthroplasty – a changing paradigm. J Arthroplasty 29:1285–1288PubMed

Singh JA (2011) Epidemiology of knee and hip arthroplasty: a systematic review. Open Orthop J 5:80–85PubMedPubMedCentral

Tsantes AG, Papadopoulos DV, Lytras T et al (2019) Association of malnutrition with periprosthetic joint and surgical site infections after total joint arthroplasty: a systematic review and meta-analysis. J Hosp Infect 103:69–77PubMed

Street MWJ, Howard LC, Neufeld ME, Masri BA (2022) Vascular injuries during hip and knee replacement. Orthop Clin North Am 53:1–12PubMed

Regensteiner JG, Hiatt WR (2002) Current medical therapies for patients with peripheral arterial disease: a critical review. Am J Med 112:49–57PubMed

Lussana F, Squizzato A, Permunian ET, Cattaneo M (2014) A systematic review on the effect of aspirin in the prevention of post-operative arterial thrombosis in patients undergoing total hip and total knee arthroplasty. Thromb Res 134:599–603PubMed

Leung AG, Cabanela ME (1998) Aortic thrombosis after acetabular revision of a total hip arthroplasty. J Arthroplasty 13:961–965PubMed

Trousdale RT, Donnelly RS, Hallett JW (1999) Thrombosis of an aortobifemoral bypass graft after total hip arthroplasty. J Arthroplasty 14:386–390PubMed

Chou TY, Su TW, Jou HJ et al (2015) Increased risk of peripheral arterial disease after hip replacement: an 11-year retrospective population-based cohort study. Medicine (Baltimore) 94:e870PubMedPubMedCentral

10.

Mori I, Machida Y, Osanai M, Iinuma K (2013) Photon starvation artifacts of X-ray CT: their true cause and a solution. Radiol Phys Technol 6:130–141PubMed

11.

Brooks RA, Di Chiro G (1976) Beam hardening in x-ray reconstructive tomography. Phys Med Biol 21:390–398PubMed

12.

Wellenberg RHH, Hakvoort ET, Slump CH, Boomsma MF, Maas M, Streekstra GJ (2018) Metal artifact reduction techniques in musculoskeletal CT-imaging. Eur J Radiol 107:60–69PubMed

13.

Leithner D, Mahmoudi S, Wichmann JL et al (2018) Evaluation of virtual monoenergetic imaging algorithms for dual-energy carotid and intracerebral CT angiography: effects on image quality, artefacts and diagnostic performance for the detection of stenosis. Eur J Radiol 99:111–117PubMed

14.

Hamid S, Nasir MU, So A, Andrews G, Nicolaou S, Qamar SR (2021) Clinical applications of dual-energy CT. Korean J Radiol 22:970–982PubMedPubMedCentral

15.

Albrecht MH, Trommer J, Wichmann JL et al (2016) Comprehensive comparison of virtual monoenergetic and linearly blended reconstruction techniques in third-generation dual-source dual-energy computed tomography angiography of the thorax and abdomen. Invest Radiol 51:582–590PubMed

16.

Albrecht MH, Scholtz JE, Husers K et al (2016) Advanced image-based virtual monoenergetic dual-energy CT angiography of the abdomen: optimization of kiloelectron volt settings to improve image contrast. Eur Radiol 26:1863–1870PubMed

17.

Neuhaus V, Grosse Hokamp N, Zopfs D et al (2019) Reducing artifacts from total hip replacements in dual layer detector CT: combination of virtual monoenergetic images and orthopedic metal artifact reduction. Eur J Radiol 111:14–20PubMed

18.

Park J, Kim SH, Han JK (2019) Combined application of virtual monoenergetic high keV images and the orthopedic metal artifact reduction algorithm (O-MAR): effect on image quality. Abdom Radiol (NY) 44:756–765PubMed

19.

Bongers MN, Schabel C, Thomas C et al (2015) Comparison and combination of dual-energy- and iterative-based metal artefact reduction on hip prosthesis and dental implants. PLoS One 10:e0143584PubMedPubMedCentral

20.

Han SC, Chung YE, Lee YH, Park KK, Kim MJ, Kim KW (2014) Metal artifact reduction software used with abdominopelvic dual-energy CT of patients with metal hip prostheses: assessment of image quality and clinical feasibility. AJR Am J Roentgenol 203:788–795PubMed

21.

Sudarski S, Apfaltrer P, Nance JW Jr et al (2013) Optimization of keV-settings in abdominal and lower extremity dual-source dual-energy CT angiography determined with virtual monoenergetic imaging. Eur J Radiol 82:e574–581PubMed

22.

Goo HW, Goo JM (2017) Dual-energy CT: new horizon in medical imaging. Korean J Radiol 18:555–569PubMedPubMedCentral

23.

Yu L, Leng S, McCollough CH (2012) Dual-energy CT-based monochromatic imaging. AJR Am J Roentgenol 199:S9–S15PubMed

24.

Delesalle MA, Pontana F, Duhamel A et al (2013) Spectral optimization of chest CT angiography with reduced iodine load: experience in 80 patients evaluated with dual-source, dual-energy CT. Radiology 267:256–266PubMed

25.

Laukamp KR, Lennartz S, Neuhaus VF et al (2018) 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 28:4524–4533PubMed

26.

Neuhaus V, Grosse Hokamp N, Abdullayev N et al (2017) Metal artifact reduction by dual-layer computed tomography using virtual monoenergetic images. Eur J Radiol 93:143–148PubMed

27.

Yin XP, Gao BL, Li CY et al (2018) Optimal monochromatic imaging of spectral computed tomography potentially improves the quality of hepatic vascular imaging. Korean J Radiol 19:578–584PubMedPubMedCentral

28.

Kosmas C, Hojjati M, Young PC, Abedi A, Gholamrezanezhad A, Rajiah P (2019) Dual-layer spectral computerized tomography for metal artifact reduction: small versus large orthopedic devices. Skeletal Radiol 48:1981–1990PubMed

29.

Grosse Hokamp N, Neuhaus V, Abdullayev N et al (2018) Reduction of artifacts caused by orthopedic hardware in the spine in spectral detector CT examinations using virtual monoenergetic image reconstructions and metal-artifact-reduction algorithms. Skeletal Radiol 47:195–201PubMed

30.

Hilgers G, Nuver T, Minken A (2014) The CT number accuracy of a novel commercial metal artifact reduction algorithm for large orthopedic implants. J Appl Clin Med Phys 15:4597PubMed

31.

Lewis M, Reid K, Toms AP (2013) Reducing the effects of metal artefact using high keV monoenergetic reconstruction of dual energy CT (DECT) in hip replacements. Skeletal Radiol 42:275–282PubMed

32.

Dangelmaier J, Schwaiger BJ, Gersing AS et al (2018) Dual layer computed tomography: reduction of metal artefacts from posterior spinal fusion using virtual monoenergetic imaging. Eur J Radiol 105:195–203PubMed

33.

Lee YH, Park KK, Song HT, Kim S, Suh JS (2012) Metal artefact reduction in gemstone spectral imaging dual-energy CT with and without metal artefact reduction software. Eur Radiol 22:1331–1340PubMed

34.

Vlahos I, Godoy MC, Naidich DP (2010) Dual-energy computed tomography imaging of the aorta. J Thorac Imaging 25:289–300PubMed

35.

Bae K, Jeon KN, Cho SB et al (2018) Improved opacification of a suboptimally enhanced pulmonary artery in chest CT: experience using a dual-layer detector spectral CT. AJR Am J Roentgenol 210:734–741PubMed

36.

Ozawa Y, Hara M, Shibamoto Y (2011) The frequency of insufficient contrast enhancement of the pulmonary artery in routine contrast-enhanced chest CT and its improvement with an increased injection rate: a prospective study. J Thorac Imaging 26:42–47PubMed

37.

Mangold S, De Cecco CN, Schoepf UJ et al (2016) A noise-optimized virtual monochromatic reconstruction algorithm improves stent visualization and diagnostic accuracy for detection of in-stent re-stenosis in lower extremity run-off CT angiography. Eur Radiol 26:4380–4389PubMed

38.

Zhang D, Xie Y, Wang Y et al (2020) Initial clinical experience of virtual monoenergetic imaging improves stent visualization in lower extremity run-off CT angiography by dual-layer spectral detector CT. Acad Radiol 27:825–832PubMed

39.

Selles M, Stuivenberg VH, Wellenberg RHH et al (2021) Quantitative analysis of metal artifact reduction in total hip arthroplasty using virtual monochromatic imaging and orthopedic metal artifact reduction, a phantom study. Insights Imaging 12:171PubMedPubMedCentral

40.

Wellenberg RH, Boomsma MF, van Osch JA et al (2017) Low-dose CT imaging of a total hip arthroplasty phantom using model-based iterative reconstruction and orthopedic metal artifact reduction. Skeletal Radiol 46:623–632PubMedPubMedCentral

41.

Krishna S, Sadoughi N, McInnes MDF, Chatelain R, MacDonald DB, Schieda N (2018) Attenuation and degree of enhancement with conventional 120-kVp polychromatic CT and 70-keV monochromatic rapid kilovoltage-switching dual-energy CT in cystic and solid renal masses. AJR Am J Roentgenol 211:789–796PubMed

42.

Wellenberg RH, Boomsma MF, van Osch JA et al (2017) Quantifying metal artefact reduction using virtual monochromatic dual-layer detector spectral CT imaging in unilateral and bilateral total hip prostheses. Eur J Radiol 88:61–70PubMed

43.

Yu L, Christner JA, Leng S, Wang J, Fletcher JG, McCollough CH (2011) Virtual monochromatic imaging in dual-source dual-energy CT: radiation dose and image quality. Med Phys 38:6371–6379PubMedPubMedCentral

44.

Pessis E, Campagna R, Sverzut JM et al (2013) Virtual monochromatic spectral imaging with fast kilovoltage switching: reduction of metal artifacts at CT. Radiographics 33:573–583PubMed

Title: Optimal combination periprosthetic vasculature visualization and metal artifact reduction by spectral computed tomography using virtual monoenergetic images in total hip arthroplasty
Authors: Jie Zhao
Qiang Cheng
Chuan Liu
Qiqi Wang
Yuchan Lv
Ziyi Tang
Yuxi Luo
Haitao Yang
Publication date: 01-12-2023
Publisher: Springer Vienna
Published in: Insights into Imaging / Issue 1/2023
Electronic ISSN: 1869-4101
DOI: https://doi.org/10.1186/s13244-023-01533-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Optimal combination periprosthetic vasculature visualization and metal artifact reduction by spectral computed tomography using virtual monoenergetic images in total hip arthroplasty

Abstract

Objectives

Methods

Results

Conclusion

Critical relevance statement

Key points

Graphical Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusion

Critical relevance statement

Key points

Graphical Abstract

Please log in to get access to this content

Other articles of this Issue 1/2023

Role of breath-hold lung PET in stage IA pulmonary adenocarcinoma

Natural language processing for automatic evaluation of free-text answers — a feasibility study based on the European Diploma in Radiology examination

Integrative diagnostics: the time is now—a report from the International Society for Strategic Studies in Radiology

Three-dimensional multifrequency magnetic resonance elastography improves preoperative assessment of proliferative hepatocellular carcinoma

Best imaging signs identified by radiomics could outperform the model: application to differentiating lung carcinoid tumors from atypical hamartomas

Comparison of sound touch elastography and quantification for assessing the renal pathologic changes in patients with proteinuria