title: Metal Artifact Reduction: Added Value of Rapid-Kilovoltage-Switching Dual-Energy CT in Relation to Single-Energy CT in a Piglet Animal Model.
abstract: OBJECTIVE
  The purpose of this article is to evaluate virtual monochromatic spectral imaging and metal artifact reduction software for reducing metal artifact and to compare it with conventional single-energy CT (SECT) in an animal model.
  
  
  METHODS
  Postmortem juvenile (n = 5) and adult (n = 1) swine specimens were scanned with SECT followed by a dual-energy CT (DECT) pediatric protocol after the insertion of two rods into their paraspinal thoracolumbar regions. Virtual monochromatic spectral images were extrapolated from DECT images at five monoenergetic levels (64, 69, 75, 88, and 105 keV) with and without the use of metal artifact reduction software. Images were evaluated by a 5-point scoring system for the extent of metallic artifacts and image interpretability in soft-tissue and bone windows. The density in the most pronounced artifact was measured. CT dose index was recorded.
  
  
  RESULTS
  In studies without metal artifact reduction software, higher energy reconstructions resulted in fewer artifacts and better image interpretability in both soft-tissue and bone windows (p < 0.0001). Artifact density decreased from -792 HU at 64 keV to -128 HU at 105 keV without the use of metal artifact reduction software. No difference was noted in attributes' scores or in artifact density in studies using metal artifact reduction software (p > 0.05). DECT studies showed lower scores compared with SECT with regard to all attributes. A new faint perimetallic hypodense halo was seen in all studies with metal artifact reduction software. The CT dose index of DECT was 1.18-3.56 times higher than that of SECT techniques.
  
  
  CONCLUSIONS
  DECT at all energy levels with metal artifact reduction software and higher energy extrapolations without metal artifact reduction software reduced metallic artifact and enhanced image interpretability compared with SECT. Radiation dose with DECT could be significantly higher than SECT.
authors: 1 Department of Radiology, The Hospital for Sick Children, Toronto, ON, Canada.|2 Present address: Department of Diagnostic Imaging, McMaster Children's Hospital, 1200 Main St W, Hamilton, ON L8N 3Z5, Canada.
authors: Heba S
authors: HS
authors: Takrouri
authors: 1 Department of Radiology, The Hospital for Sick Children, Toronto, ON, Canada.|2 Present address: Department of Diagnostic Imaging, McMaster Children's Hospital, 1200 Main St W, Hamilton, ON L8N 3Z5, Canada.
authors: Mutaz M
authors: MM
authors: Alnassar
authors: 1 Department of Radiology, The Hospital for Sick Children, Toronto, ON, Canada.
authors: Afsaneh
authors: A
authors: Amirabadi
authors: 1 Department of Radiology, The Hospital for Sick Children, Toronto, ON, Canada.|3 Present address: Department of Medical Imaging, University of Saskatchewan and Saskatoon Health Region, Saskatoon, SK, Canada.
authors: Paul S
authors: PS
authors: Babyn
authors: 4 Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
authors: Rahim
authors: R
authors: Moineddin
authors: 1 Department of Radiology, The Hospital for Sick Children, Toronto, ON, Canada.
authors: Nancy L
authors: NL
authors: Padfield
authors: 1 Department of Radiology, The Hospital for Sick Children, Toronto, ON, Canada.
authors: Guila
authors: G
authors: BenDavid
authors: 1 Department of Radiology, The Hospital for Sick Children, Toronto, ON, Canada.
authors: Andrea S
authors: AS
authors: Doria
mesh_terms: D000818:Animals; D016477:Artifacts; D008161:Lumbosacral Region; D008670:Metals; D023421:Models, Animal; D061330:Multidetector Computed Tomography / Q000379:methods*; D019736:Prostheses and Implants; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013552:Swine
chemical_list: D008670:Metals
keywords: dual-energy CT; metallic artifact reduction software; metallic artifacts; monoenergetic levels; piglet model; single-energy CT