Reduction of Metal Artifacts Caused by Titanium Peduncular Screws in the Spine by Means of Monoenergetic Images and the Metal Artifact Reduction Software in Dual-Energy Computed Tomography

Objectives: To evaluate the reduction of metal artifacts in patients with titanium peduncular screws in the spine using (1) conventional images (CI), (2) virtual monoenergetic reconstructions (VMRs), and (3) VMR + Metal Artifact Reduction Software (VMR + MARS), with dual-energy computed tomography (DECT). Materials and Methods: Twenty-four patients with titanium peduncular screws in the spine were studied using a 64-channel DECT. During the postprocessing phase, the CI, the VMRs from 100 to 140 keV, and the VMR at 140 keV + MARS were synthesized. All the images were considered, and a quantitative evaluation was performed measuring the attenuation values (in terms of Hounsfield Units) with region of interest, in correspondence with the most hyperdense and hypodense artifacts. All the values were then compared. A qualitative evaluation, in terms of image quality and extent of artifacts, was also performed by two radiologists. Results: In quantitative terms, the 140 keV + MARS reconstruction was able to significantly reduce both bright and dark metal artifacts, compared to CI and to VMRs. The VMR was capable of significantly reducing both dark and bright artifacts, compared to CI. In qualitative terms, the VMR at 140 keV proved to be the best, compared to CI and VMR + MARS images. Conclusions: The VMR + MARS image reduces metal artifacts from titanium peduncular screws more than VMRs alone and CI. Furthermore, the VMR can decrease metal artifacts from a quantitative and a qualitative point of view. Combining information from VMRs and VMR + MARS images could be the best way to solve the issue of metal artifacts on computed tomography images.