Preclinical validation of a novel deep learning-based metal artifact correction algorithm for orthopedic CT imaging

Purpose: To validate a novel deep learning-based metal artifact correction (MAC) algorithm for CT, namely, AI-MAC, in preclinical setting with comparison to conventional MAC and virtual monochromatic imaging (VMI) technique.Materials and methods: An experimental phantom was designed by consecutively inserting two sets of pedicle screws (size phi 6.5 x 30-mm and phi 7.5 x 40-mm) into a vertebral specimen to simulate the clinical scenario of metal implantation. The resulting MAC, VMI, and AI-MAC images were compared with respect to the metal-free reference image by subjective scoring, as well as by CT attenuation, image noise, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and correction accuracy via adaptive segmentation of the paraspinal muscle and vertebral body.Results: The AI-MAC and VMI images showed significantly higher subjective scores than the MAC image (all p < 0.05). The SNRs and CNRs on the AI-MAC image were comparable to the reference (all p > 0.05), whereas those on the VMI were significantly lower (all p < 0.05). The paraspinal muscle segmented on the AI-MAC image was 4.6% and 5.1% more complete to the VMI and MAC images for the phi 6.5 x 30-mm screws, and 5.0% and 5.1% for the phi 7.5 x 40-mm screws, respectively. The vertebral body segmented on the VMI was closest to the reference, with only 3.2% and 7.4% overestimation for phi 6.5 x 30-mm and phi 7.5 x 40-mm screws, respectively.Conclusions: Using metal-free reference as the ground truth for comparison, the AI-MAC outperforms VMI in characterizing soft tissue, while VMI is useful in skeletal depiction.