Dual-Energy and Iterative Metal Artifact Reduction for Reducing Artifacts Due to Metallic Hardware: A Loosening Hip Phantom Study.

The purpose of this study was to compare the value of iterative metal artifact reduction (IMAR) with that of dual-energy CT (DECT) and filtered back projection (FBP) CT protocols for reducing metal artifacts and for facilitating visualization of the acetabular cortex in a loosening hip phantom model. CT scans were obtained with conventional FBP and dual-source CT for two types of hip phantom. For the quantitative study, attenuation was measured by placement of ROIs in the phantoms around the metallic hardware. The differences between mean attenuation in each ROI and the actual attenuation were compared among the three CT protocols. For the qualitative study, the visibility of the acetabular cortex in the artificial loosening area of the total hip arthroplasty model and in the joint space of the bipolar hemiarthroplasty model was evaluated by measurement of the obscured cortical angle. In the quantitative study, attenuation differences in the bipolar hemiarthroplasty model were markedly decreased with IMAR and DECT compared with FBP ( = 0.006-0.007). In the total hip replacement model, attenuation differences were significantly lower with IMAR than with FBP ( < 0.001). In the qualitative study, visibility of the acetabular cortex was markedly improved with IMAR compared with DECT and FBP ( < 0.001) for both hip models. CT with IMAR can reduce the distortion caused by metal artifacts more effectively than FBP and DECT can while preserving visibility of the acetabular cortex in both bipolar hemiarthroplasty and total hip arthroplasty phantoms.