Metal Artifact Reduction: Added Value of Rapid-Kilovoltage-Switching Dual-Energy CT in Relation to Single-Energy CT in a Piglet Animal Model.

OBJECTIVE: The purpose of this article is to evaluate virtual monochromatic spectral imaging and metal artifact reduction software for reducing metal artifact and to compare it with conventional single-energy CT (SECT) in an animal model. MATERIALS AND METHODS: Postmortem juvenile (n = 5) and adult (n = 1) swine specimens were scanned with SECT followed by a dual-energy CT (DECT) pediatric protocol after the insertion of two rods into their paraspinal thoracolumbar regions. Virtual monochromatic spectral images were extrapolated from DECT images at five monoenergetic levels (64, 69, 75, 88, and 105 keV) with and without the use of metal artifact reduction software. Images were evaluated by a 5-point scoring system for the extent of metallic artifacts and image interpretability in soft-tissue and bone windows. The density in the most pronounced artifact was measured. CT dose index was recorded. RESULTS: In studies without metal artifact reduction software, higher energy reconstructions resulted in fewer artifacts and better image interpretability in both soft-tissue and bone windows (p < 0.0001). Artifact density decreased from -792 HU at 64 keV to -128 HU at 105 keV without the use of metal artifact reduction software. No difference was noted in attributes' scores or in artifact density in studies using metal artifact reduction software (p > 0.05). DECT studies showed lower scores compared with SECT with regard to all attributes. A new faint perimetallic hypodense halo was seen in all studies with metal artifact reduction software. The CT dose index of DECT was 1.18-3.56 times higher than that of SECT techniques. CONCLUSION: DECT at all energy levels with metal artifact reduction software and higher energy extrapolations without metal artifact reduction software reduced metallic artifact and enhanced image interpretability compared with SECT. Radiation dose with DECT could be significantly higher than SECT.