J Korean Soc Radiol.  2018 Jan;78(1):22-29. 10.3348/jksr.2018.78.1.22.

Comparison of Metal Artifact Reduction for Orthopedic Implants versus Standard Filtered Back Projection: Value of Postoperative CT after Hip Replacement

• Rim J
• Choi JA
• Lee SA
• Khil EK

• KMID: 2399302
• DOI: http://doi.org/10.3348/jksr.2018.78.1.22

Abstract

PURPOSE
To evaluate Metal Artifact Reduction for Orthopedic Implants (O-MAR, Philips Healthcare) technique compared with standard filtered back projection (SFBP) technique on post-operative hip CT regarding image noise reduction and detection of post-operative complications.
MATERIALS AND METHODS
Fifty-six hip CT scans after hip replacement with SFBP technique and O-MAR application were retrospectively reviewed. Region of interests (ROIs) were drawn at levels wherein acetabular cup and femoral head were largest at anterior and posterior acetabula, gluteus maximus muscle, subcutaneous fat adjacent to gluteus maximus muscle, and in area adjacent to prosthesis stem wherein lesser trochanter is largest. Hounsfield units (HU) were measured to evaluate artifact quantitatively; mean and standard deviations (SDs) calculated and compared. Periprosthetic complications were evaluated, and visibility rated between two reconstruction techniques; 1-SFBP better, 2-SFBP same as O-MAR, 3-O-MAR better.
RESULTS
Average HU was significantly lower in O-MAR at posterior acetabulum, gluteus maximus muscle, and subcutaneous fat (p < 0.05). SD for HU was significantly lower in O-MAR at all ROIs (p < 0.05). Mean visibility of periprosthetic complications was 2.0, so equivalent.
CONCLUSION
Reconstruction with O-MAR technique in post-operative hip CT scans after hip replacement yielded statistically significant decrease in image noise. However, visibility of periprosthetic complications was not impacted by reconstruction technique.

MeSH Terms

Acetabulum
Artifacts*
Femur
Head
Hip*
Metals
Noise
Orthopedics*
Prostheses and Implants
Retrospective Studies
Subcutaneous Fat
Tomography, X-Ray Computed
Metals

Figure

• 

  Fig. 1 Axial CT images are reconstructed using SFBP (A) technique and O-MAR (B) technique, and periprosthetic structures are obscured by streak artifact on SFBP image (A) but is clearly visualized on O-MAR image (B). O-MAR = Metal Artifact Reduction for Orthopedic Implants, SFBP = standard filtered back projection

• 

  Fig. 2 Attenuations are measured on postoperative CT scans with standard filtered back projection technique by placing region of interests (circles) within anterior (1) and posterior (2) acetabula, gluteus maximus muscle (3), subcutaneous fat (4) adjacent to gluteus maximus muscle wherein there is maximal streak artifact on an axial image at the levels where acetabular cup and femoral head are largest.

• 

  Fig. 3 Post-operative CT scans with Metal Artifact Reduction for Orthopedic Implants technique of an 81-year-old female patient with right bipolar hemiarthroplasty. A. Attenuations are measured on post-operative CT scans by placing ROIs (circles) within anterior (1) and posterior (2) acetabula, gluteus maximus muscle (3), subcutaneous fat (4) adjacent to gluteus maximus muscle on axial image at levels wherein acetabular cup and femoral head are largest, and each ROI was fully contained within tissue being measured. B. Attenuation is measured on postoperative CT scans by placing ROIs (circle) within areas adjacent to the prosthesis stem wherein the lesser trochanter is largest, and each ROI was fully contained within tissue being measured. ROI = region of interests

• 

  Fig. 4 A 47-year-old male with complications after left total hip replacement arthroplasty. A. Axial CT image with standard filtered back projection technique shows a loosening with osteolysis at left acetabulum and around proximal stem (arrows). B. There is wearing at superior aspect of polyethylene liner on coronal CT image with Metal Artifact Reduction for Orthopedic Implants technique (long arrow). Loosening with osteolysis around proximal stem is noted (short arrow).

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