Metallic dental artifact reduction in computed tomography (Smart MAR): Improvement of image quality and diagnostic confidence in patients with suspected head and neck pathology and oral implants. Issue 118 (September 2019)

• Record Type: Journal Article
• Authors: Feldhaus, Felix; Böning, Georg; Jonczyk, Martin; Kahn, Johannes; Fehrenbach, Uli; Maurer, M.; Renz, D.; Hamm, Bernd; Streitparth, Florian
• Is Part Of: European journal of radiology. Issue 118(2019)
• Page Start: 153
• Page End: 160
• Publication Date: 2019-09
• Subjects: CNR Contrast-to-noise ratio -- CT Computed tomography -- CTDI Computed tomography dose index -- DE-CT Dual-energy computed tomography -- DLP Dose-length product (in mGy*cm) -- HU Hounsfield unit -- IJV Internal jugular vein -- IQR Interquartile range -- MAR Metal artifact reduction -- MS-CT Multislice computed tomography -- ROI Region of interest -- SD Standard deviation -- SNR Signal-to-noise ratio -- SS-CT Single-source computed tomography; Computer-assisted image processing -- Artifacts -- Neck -- Squamous cell carcinoma; Medical radiology -- Periodicals; Radiology -- Periodicals; Radiologie médicale -- Périodiques; Medical radiology; Periodicals; 616.075705
• DOI: 10.1016/j.ejrad.2019.07.015
• Languages: English
• ISSNs: 0720-048X

Abstract

Abstract: Purpose: We determined whether the Smart MAR metal artifact reduction tool - a three-stage, projection-based, post processing algorithm - improves subjective and objective image quality and diagnostic confidence in patients with dental artifacts and suspected head and neck pathology compared to standard adaptive statistical iterative reconstructions (ASIR V) alone. Method: The study included 100 consecutive patients with nonremovable oral implants or dental fillings and suspected oropharyngeal cancer or abscess. CT raw data of a single-source multislice CT scanner were postprocessed using ASIR V alone and with additional Smart MAR reconstruction. Image quality of baseline ASIR V and Smart MAR-based reconstruction series was compared both quantitatively (5 regions of interest, ROIs) and qualitatively (two independent raters). Results: Additional Smart MAR reconstruction significantly seems to improve both attenuation and noise adjacent to implants and in more distant areas (all p < 0.001) compared to standard ASIR V reconstructions alone. Signal-to-noise ratio (SNR; p = 0.001) and contrast-to-noise ratio were improved significantly (CNR; p = 0.001). Smart MAR improved visualization of tumor/abscess (detected in 36 of 100 patients, 36%) and representative oropharyngeal tissue (p < 0.001). In 8 of 36 patients (22%), tumor was only detected in Smart MAR series. Mean total DLP was 506.8mGy*cm; average CTDIvol was 5.5 mGy. Conclusions: The supplementary use of the Smart MAR post-processing tool seems to significantly improve both subjective and objective image quality as well as diagnostic confidence and lesion detection in CT of the head and neck. In 22% of cases, the tumor was detected only in Smart MAR reconstructed images.