Artifact reduction from dental implants using virtual monoenergetic reconstructions from novel spectral detector CT

Objectives: Image quality in head and neck imaging is often severely hampered by artifacts arising from dental implants. This study evaluates metal artifact (MA) reduction using virtual monoenergetic images (VMI) compared to conventional CT images (CI) from spectral-detector computed tomography (SDCT). Methods: 38 consecutive patients with dental implants were included in this retrospective study. All examinations were performed using a SDCT (IQon, Philips, Best, The Netherlands). Images were reconstructed as conventional images (CI) and as VMI in a range of 40-200 keV (10 keV increment). Quantitative image analysis was performed ROI-based by measurement of attenuation (HU) and standard deviation in most pronounced hypo-and hyperdense artifact, fat and soft tissue with presence of artifacts. Qualitatively, extent of artifact reduction, assessment of soft palate and cheeks were rated on 5-point Likert-scales by two radiologists. Statistical data evaluation included ANOVA and Wilcoxon-test with correction for multiple comparisons; interrater-agreement was determined by intraclass-correlation coefficient (ICC). Results: The hypo- and hyperattenuating artifacts showed an increase and decrease of HU-values in VMIhigh (CI/VMI200kev: -218.7/ -174.4 HU, p = 0.1; and 309.8/119.2, p <= 0.05, respectively). Artifacts in the fat, as depicted by image noise did also decrease in VMIhigh (CI/VMI200kev: 23.9/16.4, p <= 0.05). Qualitatively, hyperdense artifacts were decreased significantly in VMI >= 100 keV (e.g. CI/VMI200kev: 2(1-3)/3(1-5), p <= 0.05). Artifact reduction resulted in improved assessment of the soft palate and cheeks (e.g. CI/VMI200kev: 2(1-4)/3(1-5) and 2(1-5)/3(1-5), p <= 0.05). Overall interrater agreement was good (ICC = 0.77). Conclusions: Virtual monoenergetic images from SDCT reduce metal artifacts from dental implants and improve diagnostic assessment of surrounding soft tissue.