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Improved Turnaround Times | Median time to first decision: 12 days

Research ArticleSpine Imaging and Spine Image-Guided Interventions

CT Metal Artifact Reduction in the Spine: Can an Iterative Reconstruction Technique Improve Visualization?

A.L. Kotsenas, G.J. Michalak, D.R. DeLone, F.E. Diehn, K. Grant, A.F. Halaweish, A. Krauss, R. Raupach, B. Schmidt, C.H. McCollough and J.G. Fletcher
American Journal of Neuroradiology August 2015, DOI: https://doi.org/10.3174/ajnr.A4416
A.L. Kotsenas
From the Department of Radiology (A.L.K., G.J.M., D.R.D., F.E.D., C.H.M., J.G.F.), Mayo Clinic, Rochester, Minnesota; Siemens Medical Solutions (K.G., A.F.H.), Malvern, Pennsylvania; and Siemens Healthcare (A.K., R.R., B.S.), Forchheim, Germany.
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G.J. Michalak
From the Department of Radiology (A.L.K., G.J.M., D.R.D., F.E.D., C.H.M., J.G.F.), Mayo Clinic, Rochester, Minnesota; Siemens Medical Solutions (K.G., A.F.H.), Malvern, Pennsylvania; and Siemens Healthcare (A.K., R.R., B.S.), Forchheim, Germany.
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D.R. DeLone
From the Department of Radiology (A.L.K., G.J.M., D.R.D., F.E.D., C.H.M., J.G.F.), Mayo Clinic, Rochester, Minnesota; Siemens Medical Solutions (K.G., A.F.H.), Malvern, Pennsylvania; and Siemens Healthcare (A.K., R.R., B.S.), Forchheim, Germany.
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F.E. Diehn
From the Department of Radiology (A.L.K., G.J.M., D.R.D., F.E.D., C.H.M., J.G.F.), Mayo Clinic, Rochester, Minnesota; Siemens Medical Solutions (K.G., A.F.H.), Malvern, Pennsylvania; and Siemens Healthcare (A.K., R.R., B.S.), Forchheim, Germany.
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K. Grant
From the Department of Radiology (A.L.K., G.J.M., D.R.D., F.E.D., C.H.M., J.G.F.), Mayo Clinic, Rochester, Minnesota; Siemens Medical Solutions (K.G., A.F.H.), Malvern, Pennsylvania; and Siemens Healthcare (A.K., R.R., B.S.), Forchheim, Germany.
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A.F. Halaweish
From the Department of Radiology (A.L.K., G.J.M., D.R.D., F.E.D., C.H.M., J.G.F.), Mayo Clinic, Rochester, Minnesota; Siemens Medical Solutions (K.G., A.F.H.), Malvern, Pennsylvania; and Siemens Healthcare (A.K., R.R., B.S.), Forchheim, Germany.
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A. Krauss
From the Department of Radiology (A.L.K., G.J.M., D.R.D., F.E.D., C.H.M., J.G.F.), Mayo Clinic, Rochester, Minnesota; Siemens Medical Solutions (K.G., A.F.H.), Malvern, Pennsylvania; and Siemens Healthcare (A.K., R.R., B.S.), Forchheim, Germany.
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R. Raupach
From the Department of Radiology (A.L.K., G.J.M., D.R.D., F.E.D., C.H.M., J.G.F.), Mayo Clinic, Rochester, Minnesota; Siemens Medical Solutions (K.G., A.F.H.), Malvern, Pennsylvania; and Siemens Healthcare (A.K., R.R., B.S.), Forchheim, Germany.
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B. Schmidt
From the Department of Radiology (A.L.K., G.J.M., D.R.D., F.E.D., C.H.M., J.G.F.), Mayo Clinic, Rochester, Minnesota; Siemens Medical Solutions (K.G., A.F.H.), Malvern, Pennsylvania; and Siemens Healthcare (A.K., R.R., B.S.), Forchheim, Germany.
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C.H. McCollough
From the Department of Radiology (A.L.K., G.J.M., D.R.D., F.E.D., C.H.M., J.G.F.), Mayo Clinic, Rochester, Minnesota; Siemens Medical Solutions (K.G., A.F.H.), Malvern, Pennsylvania; and Siemens Healthcare (A.K., R.R., B.S.), Forchheim, Germany.
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J.G. Fletcher
From the Department of Radiology (A.L.K., G.J.M., D.R.D., F.E.D., C.H.M., J.G.F.), Mayo Clinic, Rochester, Minnesota; Siemens Medical Solutions (K.G., A.F.H.), Malvern, Pennsylvania; and Siemens Healthcare (A.K., R.R., B.S.), Forchheim, Germany.
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Abstract

BACKGROUND AND PURPOSE: Metal-related artifacts from spine instrumentation can obscure relevant anatomy and pathology. We evaluated the ability of CT images reconstructed with and without iterative metal artifact reduction to visualize critical anatomic structures in postoperative spines and assessed the potential for implementation into clinical practice.

MATERIALS AND METHODS: We archived CT projection data in patients with instrumented spinal fusion. CT images were reconstructed by using weighted filtered back-projection and iterative metal artifact reduction. Two neuroradiologists evaluated images in the region of spinal hardware and assigned a score for the visualization of critical anatomic structures by using soft-tissue and bone windows (critical structures totally obscured, n = 0; anatomic recognition with high diagnostic confidence, n = 5). Using bone windows, we measured the length of the most pronounced linear artifacts. For each patient, neuroradiologists made recommendations regarding the optimal use of iterative metal artifact reduction and its impact on diagnostic confidence.

RESULTS: Sixty-eight patients met the inclusion criteria. Visualization of critical soft-tissue anatomic structures was significantly improved by using iterative metal artifact reduction compared with weighted filtered back-projection (median, 1 ± 1.5 versus 3 ± 1.3, P < .001), with improvement in the worst visualized anatomic structure in 88% (60/68) of patients. There was not significant improvement in visualization of critical osseous structures. Linear metal artifacts were reduced from 29 to 11 mm (P < .001). In 87% of patients, neuroradiologists recommended reconstructing iterative metal artifact reduction images instead of weighted filtered back-projection images, with definite improvement in diagnostic confidence in 32% (22/68).

CONCLUSIONS: Iterative metal artifact reduction improves visualization of critical soft-tissue structures in patients with spinal hardware. Routine generation of these images in addition to routine weighted filtered back-projection is recommended.

Abbreviations

IMAR
iterative metal artifact reduction
wFBP
weighted filtered back-projection
HU
Hounsfield units
  • © 2015 American Society of Neuroradiology
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CT Metal Artifact Reduction in the Spine: Can an Iterative Reconstruction Technique Improve Visualization?
A.L. Kotsenas, G.J. Michalak, D.R. DeLone, F.E. Diehn, K. Grant, A.F. Halaweish, A. Krauss, R. Raupach, B. Schmidt, C.H. McCollough, J.G. Fletcher
American Journal of Neuroradiology Aug 2015, DOI: 10.3174/ajnr.A4416
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Cite this article
A.L. Kotsenas, G.J. Michalak, D.R. DeLone, F.E. Diehn, K. Grant, A.F. Halaweish, A. Krauss, R. Raupach, B. Schmidt, C.H. McCollough, J.G. Fletcher
CT Metal Artifact Reduction in the Spine: Can an Iterative Reconstruction Technique Improve Visualization?
American Journal of Neuroradiology Aug 2015, DOI: 10.3174/ajnr.A4416

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