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Metal Artifact Reduction in Routine Chest and Abdominal Examinations Using Virtual Monoenergetic Images From Spectral Detector Computed Tomography

Van Hedent, Steven MD, PhD*,†,‡,§; Kessner, Rivka MD*,†,∥; Große Hokamp, Nils MD*,†,¶; Baran, Tomer Ziv PhD#; Kosmas, Christos MD*,†; Gupta, Amit MD*,†

Journal of Computer Assisted Tomography: September/October 2019 - Volume 43 - Issue 5 - p 713–717
doi: 10.1097/RCT.0000000000000901
Abdominal Imaging

Objective The objective of this study was to investigate the quantitative and qualitative effects of virtual monoenergetic images (VMIs) by spectral detector computed tomography (SDCT) on metal artifacts in routine examinations.

Methods Fifty-nine patients with metal artifacts (caused by pacemakers, ports, screws, or prosthetic joints) affecting muscular tissue in the chest and/or abdomen were scanned using SDCT. Attenuation values around the metallic device were compared with contralateral unaffected values, for conventional images and 80 to 200 keV VMIs. In addition, general image quality and artifact intensity were rated by 2 readers.

Results The VMIs significantly decreased metal artifact intensity in all patients (P < 0.05). In 39 patients (66.1%), the attenuation values of the artifact and the unaffected area on the optimal keV level were very similar (≤5 Hounsfield unit difference). Qualitative analysis showed that high VMIs significantly improved artifact intensity, with best scores at 140 keV.

Conclusions High monoenergetic images of SDCT significantly reduce metal artifacts, with optimal assessment at 140 keV.

From the *Department of Radiology, University Hospitals Cleveland Medical Center

Case Western Reserve University School of Medicine, Cleveland, OH

Vrije Universiteit Brussel

§Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium

Department of Diagnostic Imaging, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

Institute for Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany

#Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Received for publication February 21, 2019; accepted June 3, 2019.

Correspondence to: Steven Van Hedent, MD, Department of Radiology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium (e-mail:

Partial funding support was provided by Philips Healthcare under a research agreement with University Hospitals Cleveland Medical Center and Case Western Reserve University.

S.V.H and R.K. contributed equally to this work.

Nils Große Hokamp is on the speaker's bureau of Philips Healthcare. The authors declare no conflict of interest.

Online date: July 29, 2019

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