title: Efficacy and Clinical Utility of a High-Attenuation Object Artifact Reduction Algorithm in Flat-Detector Image Reconstruction Compared With Standard Image Reconstruction.
abstract: OBJECTIVE
  To evaluate the effectiveness and clinical utility of a metal artifact reduction (MAR) image reconstruction algorithm for the reduction of high-attenuation object (HAO)-related image artifacts.
  
  
  METHODS
  Images were quantitatively evaluated for image noise (noiseSD and noiserange) and qualitatively for artifact severity, gray-white-matter delineation, and diagnostic confidence with conventional reconstruction and after applying a MAR algorithm.
  
  
  RESULTS
  Metal artifact reduction reduces noiseSD and noiserange (median [interquartile range]) at the level of HAO in 1-cm distance compared with conventional reconstruction (noiseSD: 60.0 [71.4] vs 12.8 [16.1] and noiserange: 262.0 [236.8] vs 72.0 [28.3]; P < 0.0001). Artifact severity (reader 1 [mean ± SD]: 1.1 ± 0.6 vs 2.4 ± 0.5, reader 2: 0.8 ± 0.6 vs 2.0 ± 0.4) at level of HAO and diagnostic confidence (reader 1: 1.6 ± 0.7 vs 2.6 ± 0.5, reader 2: 1.0 ± 0.6 vs 2.3 ± 0.7) significantly improved with MAR (P < 0.0001). Metal artifact reduction did not affect gray-white-matter delineation.
  
  
  CONCLUSIONS
  Metal artifact reduction effectively reduces image artifacts caused by HAO and significantly improves diagnostic confidence without worsening gray-white-matter delineation.
authors.affiliation: From the *Division of Radiology and Nuclear Medicine, Kantonsspital St Gallen, St Gallen, Switzerland; and †Division of Neurosurgery, Kantonsspital St Gallen, St Gallen, Switzerland.
authors.forename: Claas P
authors.initials: CP
authors.lastname: Naehle
authors.forename: Lukas
authors.initials: L
authors.lastname: Hechelhammer
authors.forename: Heiko
authors.initials: H
authors.lastname: Richter
authors.forename: Fabian
authors.initials: F
authors.lastname: Ryffel
authors.forename: Simon
authors.initials: S
authors.lastname: Wildermuth
authors.forename: Johannes
authors.initials: J
authors.lastname: Weber
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D016477:Artifacts; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D008297:Male; D008670:Metals; D008875:Middle Aged; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed / Q000295:instrumentation* / Q000379:methods*
chemical_list: D008670:Metals