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Stern, Christoph; Wanivenhaus, Florian; Rosskopf, Andrea B.; Farshad, Mazda; Sutter, Reto

Superior metal artifact reduction of tin-filtered low-dose CT in imaging of lumbar spinal instrumentation compared to conventional computed tomography

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  • Media type: E-Article
  • Title: Superior metal artifact reduction of tin-filtered low-dose CT in imaging of lumbar spinal instrumentation compared to conventional computed tomography
  • Contributor: Stern, Christoph; Wanivenhaus, Florian; Rosskopf, Andrea B.; Farshad, Mazda; Sutter, Reto
  • imprint: Springer Science and Business Media LLC, 2024
  • Published in: Skeletal Radiology
  • Language: English
  • DOI: 10.1007/s00256-023-04467-5
  • ISSN: 0364-2348; 1432-2161
  • Keywords: Radiology, Nuclear Medicine and imaging
  • Origination:
  • Footnote:
  • Description: <jats:title>Abstract</jats:title><jats:sec> <jats:title>Objective</jats:title> <jats:p>To compare the image quality of low-dose CT (LD-CT) with tin filtration of the lumbar spine after metal implants to standard clinical CT, and to evaluate the potential for metal artifact and dose reduction.</jats:p> </jats:sec><jats:sec> <jats:title>Materials and methods</jats:title> <jats:p>CT protocols were optimized in a cadaver torso. Seventy-four prospectively included patients with metallic lumbar implants were scanned with both standard CT (120 kV) and tin-filtered LD-CT (Sn140kV). CT dose parameters and qualitative measures (1 = worst,4 = best) were compared. Quantitative measures included noise, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and the width and attenuation of the most prominent hypodense metal artifact. Standard CT and LD-CT were assessed for imaging findings.</jats:p> </jats:sec><jats:sec> <jats:title>Results</jats:title> <jats:p>Tin-filtered LD-CT was performed with 60% dose saving compared to standard CT (median effective dose 3.22 mSv (quartile 1–3: 2.73–3.49 mSv) versus 8.02 mSv (6.42–9.27 mSv; <jats:italic>p</jats:italic> &lt; .001). Image quality of CT and tin-filtered low-dose CT was good with excellent depiction of anatomy, while image noise was lower for CT and artifacts were weaker for tin-filtered LD-CT. Quantitative measures also revealed increased noise for tin-filtered low-dose CT (41.5HU), lower SNR (2) and CNR (0.6) compared to CT (32HU,3.55,1.03, respectively) (all <jats:italic>p</jats:italic> &lt; .001). However, tin-filtered LD-CT performed superior regarding the width and attenuation of hypodense metal artifacts (2.9 mm and -767.5HU for LD-CT vs. 4.1 mm and -937HU for CT; all <jats:italic>p</jats:italic> &lt; .001). No difference between methods was observed in detection of imaging findings.</jats:p> </jats:sec><jats:sec> <jats:title>Conclusion</jats:title> <jats:p>Tin-filtered LD-CT with 60% dose saving performs comparable to standard CT in detection of pathology and surgery related complications after lumbar spinal instrumentation, and shows superior metal artifact reduction.</jats:p> </jats:sec>