Kämmerling Nina, Farnebo Simon, Sandstedt Mårten, Booij Ronald, Persson Anders, Tesselaar Erik
Department of Radiology, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.
Eur Radiol Exp. 2025 May 1;9(1):45. doi: 10.1186/s41747-025-00587-w.
We compared photon-counting detector computed tomography (PCD-CT) polyenergetic images, PCD-CT virtual monoenergetic images (VMI), and energy-integrating detector computed tomography (EID-CT) polyenergetic images regarding bone visualization and metal artifacts in patients with titanium wrist prostheses.
After ethical approval, 15 patients were examined with PCD-CT and EID-CT. Polyenergetic images were reconstructed, as well as 130-keV VMI for PCD-CT. Five radiologists evaluated bone visualization, interpretability at metal-bone interface and metal artifacts using a 7-point ordinal scale. Streak artifacts and artifacts at the bone-metal interface were quantitatively assessed. Differences between image setups were analyzed using Friedman test and one-way ANOVA with post hoc tests.
Bone visualization was superior in PCD-CT polyenergetic images (median rating 6, range 3-7) compared with VMI (5, 3-7; p < 0.001) and EID-CT (5, 3-7; p = 0.018). Streak artifacts were more pronounced with PCD-CT polyenergetic images (4, 3-6) compared with EID-CT (5, 4-6; p = 0.003) and PCD-CT VMI (5, 3-7; p = 0.002), with quantitative results showing least streak artifacts in PCD-CT VMI, followed by EID-CT and PCD-CT polyenergetic images (50 ± 7%, 70 ± 6%, and 79 ± 5%, respectively; p < 0.001). Interpretability at bone-metal interface was better with PCD-CT polyenergetic images (5, 2-7; p = 0.045) and EID-CT (5, 3-6; p = 0.018) compared with PCD-CT VMI (4, 2-6), without quantitative differences.
Streak artifacts from titanium wrist prostheses were reduced using 130-keV PCD-CT VMI, while bone visualization was highest using PCD-CT polyenergetic images.
In patients with wrist implants, photon-counting detector CT allows for effective metal artifact reduction using virtual monoenergetic images and improved bone visualization using polyenergetic images. As polyenergetic images and VMI have different advantages, access to both image setups may benefit diagnostic evaluation.
Virtual monoenergetic images (VMI) presented a substantial reduction of metal streak artifacts. Polyenergetic images exhibited better image quality for bone imaging compared with VMI. A combination of image reconstructions should be preferred depending on the diagnostic task.
我们比较了光子计数探测器计算机断层扫描（PCD-CT）多能图像、PCD-CT虚拟单能图像（VMI）以及能量积分探测器计算机断层扫描（EID-CT）多能图像在钛制腕关节假体患者中的骨可视化和金属伪影情况。
经伦理批准后，对15例患者进行了PCD-CT和EID-CT检查。重建了多能图像以及PCD-CT的130keV VMI。五名放射科医生使用7分有序量表评估骨可视化、金属-骨界面的可解释性和金属伪影。对条纹伪影和骨-金属界面处的伪影进行了定量评估。使用Friedman检验和带有事后检验的单因素方差分析来分析图像设置之间的差异。
与VMI（中位数评分5，范围3-7；p<0.001）和EID-CT（5，3-7；p=0.018）相比，PCD-CT多能图像的骨可视化效果更好（中位数评分6，范围3-7）。与EID-CT（5，4-6；p=0.003）和PCD-CT VMI（5，3-7；p=0.002）相比，PCD-CT多能图像的条纹伪影更明显，定量结果显示PCD-CT VMI中的条纹伪影最少，其次是EID-CT和PCD-CT多能图像（分别为50±7%、70±6%和79±5%；p<0.001）。与PCD-CT VMI（4，2-6）相比，PCD-CT多能图像（5，2-7；p=0.045）和EID-CT（5，3-6；p=0.018）在骨-金属界面的可解释性更好，且无定量差异。
使用130keV PCD-CT VMI可减少钛制腕关节假体产生的条纹伪影，而PCD-CT多能图像的骨可视化效果最佳。
对于腕部植入物患者，光子计数探测器CT能够通过虚拟单能图像有效减少金属伪影，并通过多能图像改善骨可视化。由于多能图像和VMI具有不同优势，同时获取这两种图像设置可能有利于诊断评估。
虚拟单能图像（VMI）可显著减少金属条纹伪影。与VMI相比，多能图像在骨成像方面表现出更好的图像质量。应根据诊断任务优先选择图像重建的组合方式。
