Optimal combination periprosthetic vasculature visualization and metal artifact reduction by spectral computed tomography using virtual monoenergetic images in total hip arthroplasty

OBJECTIVES: To investigate the optimal parameters of spectral CT for preferably visualizing the periprosthetic vasculature and metal artifact reduction (MAR) in total hip arthroplasty (THA). METHODS: A total of 34 THA of 30 patients were retrospectively included. Image reconstructions included conventional image (CI), CI combined with MAR (CI(MAR)), and virtual monoenergetic images (VMI) combined with MAR (VMI(MAR)) at 50–120 keV. The attenuation and standard deviation of the vessel and artifact, and the width of artifact were measured. Qualitative scoring was evaluated including the vascular contour, the extent of artifact, and overall diagnostic evaluation. RESULTS: The attenuation, noise of the vessel and artifact, and the width of artifact decreased as the energy level increased (p < 0.001). The downtrend was relatively flat at 80–120 keV, and the vascular attenuation dropped to 200 HU at 90 keV. The qualitative rating of vascular contour was significantly higher at CI(MAR) (3.47) and VMI(MAR) 60–80 keV (2.82–3.65) compared with CI (2.03) (p ≤ 0.029), and the highest score occurred at 70 and 80 keV (3.65 and 3.56). The score of the extent of artifact was higher at VMI(MAR) 80 keV than CI(MAR) (3.53 VS 3.12, p = 0.003). The score of the overall diagnostic evaluation was higher at VMI(MAR) 70 and 80 keV (3.32 and 3.53, respectively) than CI(MAR) (3.12) (p ≤ 0.035). CONCLUSION: Eighty kiloelectron volts on VMI(MAR), providing satisfactorily reduced metal artifacts and improved vascular visualization, can be an optimal recommended parameter of spectrum CT for the assessment of periprosthetic vasculature in THA patients. CRITICAL RELEVANCE STATEMENT: The metal artifact is gradually reducing with increasing energy level; however, the vascular visualization is worsening. The vascular visualization is terrible above 100 keV, while the vessel is disturbed by artifacts below 70 keV. The best performance is found at 80 keV. KEY POINTS: • VMI(MAR) can provide both reduced metal artifacts and improved vascular visualization. • Eighty kiloelectron volts on VMI(MAR) performs best in vascular visualization of total hip arthroplasty patients. • Energy spectrum CT is recommended for routine use in patients with total hip arthroplasty. GRAPHICAL ABSTRACT: [Image: see text]