Comparison of the Quality of Various Polychromatic and Monochromatic Dual-Energy CT Images with or without a Metal Artifact Reduction Algorithm to Evaluate Total Knee Arthropasty

Objective: To compare the quality of various polychromatic and monochromatic images with or without using an iterative metal artifact reduction algorithm (iMAR) obtained from a dual-energy computed tomography (CT) to evaluate total knee arthroplasty. Materials and Methods: We included 58 patients (28 mate and 30 female; mean age [range], 71.4 [61-83] years) who underwent 74 knee examinations after total knee arthroplasty using dual-energy CT. CT image sets consisted of polychromatic image sets that linearly blended 80 kVp and tin-filtered 140 kVp using weighting factors of 0.4, 0, and -0.3, and monochromatic images at 130, 150, 170, and 190 keV. These image sets were obtained with and without applying iMAR, creating a total of 14 image sets. Two readers qualitatively ranked the image quality (1 [lowest quality] through 14 [highest quality]). Volumes of high- and low-density artifacts and contrast-to-noise ratios (CNRs) between the bone and fat tissue were quantitatively measured in a subset of 25 knees unaffected by metal artifacts. Results: iMAR-applied, polychromatic images using weighting factors of -0.3 and 0.0 (P--0(.3i) and P-0.0i, respectively) showed the highest image-quality rank scores (median of 14 for both by one reader and 13 and 14, respectively, by the other reader; p < 0.001). All iMAR-applied image series showed higher rank scores than the iMAR-unapplied ones. The smallest volumes of low-density artifacts were found in P--0(.3i), P-0.0i, and iMAR-applied monochromatic images at 130 keV. The smallest volumes of high-density artifacts were noted in P--0(.3i). The CNRs were best in polychromatic images using a weighting factor of 0.4 with or without iMAR application, followed by polychromatic images using a weighting factor of 0.0 with or without iMAR application. Conclusion: Polychromatic images combined with iMAR application, P--0(.3i) and P-0 .0i, provided better image qualities and substantial metal artifact reduction compared with other image sets.