Artefacts of implant-supported single crowns - Impact of material composition on artefact volume on dental MRI.

PURPOSE: MRI allows radiation-free imaging of the head and neck area. However, implant-supported prostheses may severely impair image quality due to artefacts. Therefore, identification of preferable material compositions for implants and supported prostheses with little impact on MR image quality is mandatory. MATERIALS AND METHODS: Overall, one zirconia and four titanium dental implants were provided with different single crown materials: porcelain-fused-to-metal precious alloy (GP-T), porcelain-fused-to-metal non-precious alloy (CCT-T), porcelain-fused-to-zirconia (ZC-T) and monolithic zirconia (Z-T, Z-Z). Three-dimensional artefact volume was determined on a 3 Tesla MRI, applying two standard sequence types (SPACE and TSE). Two-way ANOVA and pair-wise post-hoc Turkey test were performed for comparison of artefact size. RESULTS: Fewest MR artefacts were observed with zirconia implant combined with monolithic zirconia crown. A titanium implant combined with a single crown framework out of the non-precious alloys was unfavourable in terms of artefact volume. Smaller and comparable artefact volumes were noted for titanium implants with the remaining three crown materials (GP-T, ZC-T and Z-T). CONCLUSIONS: Material composition of dental implants provided with single crowns has a profound impact on artefact volume. In comparison with crowns containing cobalt, chromium and tungsten, the MRI artefacts are reduced in precious alloy- and zirconia-based crowns. Further studies are needed to assess whether residual artefacts allow sufficient diagnostic imaging with these crowns. Conflict-of-interest statement: The authors have nothing to disclose.

Advanced abdominal imaging with dual energy CT is feasible without increasing radiation dose.

BACKGROUND: Dual energy CT (DECT) has proven its potential in oncological imaging. Considering the repeated follow-up examinations, radiation dose should not exceed conventional single energy CT (SECT). Comparison studies on the same scanner with a large number of patients, considering patient geometries and image quality, and exploiting full potential of SECT dose reduction are rare. Purpose of this retrospective study was to compare dose of dual source DECT versus dose-optimized SECT abdominal imaging in clinical routine. METHODS: One hundred patients (62y (±14)) had either contrast-enhanced SECT including automatic voltage control (44) or DECT (56). CT dose index (CTDIvol), size-specific dose-estimate (SSDE) and dose-length product (DLP) were reported. Image noise (SD) was recorded as mean of three ROIs placed in subcutaneous fat and normalized to dose by [Formula: see text] . For dose-normalized contrast-to-noise ratio (CNRD), mean attenuation of psoas muscle (CTmuscle) and subcutaneous fat (CTfat) were compared by CNRD = (CTmuscle - CTfat)/SDn. Statistical significance was tested with two-sided t-test (α = 0.05). RESULTS: There was no significant difference (p < 0.05) between DECT and SECT: Mean CTDIvol was 14.2 mGy (±3.9) (DECT) and 14.3 mGy (±4.5) (SECT). Mean DLP was 680 mGy*cm (±220) (DECT) and 665 mGy*cm (±231) (SECT). Mean SSDE was 15.7 mGy (±1.9) (DECT) and 16.1 mGy (±2.5) (SECT). Mean SDn was 42.2 (±13.9) HU [Formula: see text] (DECT) and 47.8 (±14.9) HU [Formula: see text] (SECT). Mean CNRD was 3.9 (±1.3) [Formula: see text]. (DECT) and 4.0 (±1.3) [Formula: see text] (SECT). CONCLUSION: Abdominal DECT is feasible without increasing radiation dose or deteriorating image quality, even compared to dose-optimized SECT including automatic voltage control. Thus DECT can contribute to sophisticated oncological imaging without dose penalty.

The application of metal artifact reduction (MAR) in CT scans for radiation oncology by monoenergetic extrapolation with a DECT scanner.

Metal artifacts in computed tomography CT images are one of the main problems in radiation oncology as they introduce uncertainties to target and organ at risk delineation as well as dose calculation. This study is devoted to metal artifact reduction (MAR) based on the monoenergetic extrapolation of a dual energy CT (DECT) dataset. In a phantom study the CT artifacts caused by metals with different densities: aluminum (ρ Al=2.7 g/cm(3)), titanium (ρ Ti=4.5 g/cm(3)), steel (ρ steel=7.9 g/cm(3)) and tungsten (ρ W=19.3g/cm(3)) have been investigated. Data were collected using a clinical dual source dual energy CT (DECT) scanner (Siemens Sector Healthcare, Forchheim, Germany) with tube voltages of 100 kV and 140 kV(Sn). For each tube voltage the data set in a given volume was reconstructed. Based on these two data sets a voxel by voxel linear combination was performed to obtain the monoenergetic data sets. The results were evaluated regarding the optical properties of the images as well as the CT values (HU) and the dosimetric consequences in computed treatment plans. A data set without metal substitute served as the reference. Also, a head and neck patient with dental fillings (amalgam ρ=10 g/cm(3)) was scanned with a single energy CT (SECT) protocol and a DECT protocol. The monoenergetic extrapolation was performed as described above and evaluated in the same way. Visual assessment of all data shows minor reductions of artifacts in the images with aluminum and titanium at a monoenergy of 105 keV. As expected, the higher the densities the more distinctive are the artifacts. For metals with higher densities such as steel or tungsten, no artifact reduction has been achieved. Likewise in the CT values, no improvement by use of the monoenergetic extrapolation can be detected. The dose was evaluated at a point 7 cm behind the isocenter of a static field. Small improvements (around 1%) can be seen with 105 keV. However, the dose uncertainty remains of the order of 10% to 20%. Thus, the improvement is not significant for radiotherapy planning. For amalgam with a density between steel and tungsten, monoenergetic data sets of a patient do not show substantial artifact reduction. The local dose uncertainties around the metal artifact determined for a static field are of the order of 5%. Although dental fillings are smaller than the phantom inserts, metal artifacts could not be reduced effectively. In conclusion, the image based monoenergetic extrapolation method does not provide efficient reduction of the consequences of CT-generated metal artifacts for radiation therapy planning, but the suitability of other MAR methods will be subsequently studied.

Performance of today's dual energy CT and future multi energy CT in virtual non-contrast imaging and in iodine quantification: A simulation study.

PURPOSE: To study the performance of different dual energy computed tomography (DECT) techniques, which are available today, and future multi energy CT (MECT) employing novel photon counting detectors in an image-based material decomposition task. METHODS: The material decomposition performance of different energy-resolved CT acquisition techniques is assessed and compared in a simulation study of virtual non-contrast imaging and iodine quantification. The material-specific images are obtained via a statistically optimal image-based material decomposition. A projection-based maximum likelihood approach was used for comparison with the authors' image-based method. The different dedicated dual energy CT techniques are simulated employing realistic noise models and x-ray spectra. The authors compare dual source DECT with fast kV switching DECT and the dual layer sandwich detector DECT approach. Subsequent scanning and a subtraction method are studied as well. Further, the authors benchmark future MECT with novel photon counting detectors in a dedicated DECT application against the performance of today's DECT using a realistic model. Additionally, possible dual source concepts employing photon counting detectors are studied. RESULTS: The DECT comparison study shows that dual source DECT has the best performance, followed by the fast kV switching technique and the sandwich detector approach. Comparing DECT with future MECT, the authors found noticeable material image quality improvements for an ideal photon counting detector; however, a realistic detector model with multiple energy bins predicts a performance on the level of dual source DECT at 100 kV/Sn 140 kV. Employing photon counting detectors in dual source concepts can improve the performance again above the level of a single realistic photon counting detector and also above the level of dual source DECT. CONCLUSIONS: Substantial differences in the performance of today's DECT approaches were found for the application of virtual non-contrast and iodine imaging. Future MECT with realistic photon counting detectors currently can only perform comparably to dual source DECT at 100 kV/Sn 140 kV. Dual source concepts with photon counting detectors could be a solution to this problem, promising a better performance.

Dual energy CT: how well can pseudo-monochromatic imaging reduce metal artifacts?

PURPOSE: Dual Energy CT (DECT) provides so-called monoenergetic images based on a linear combination of the original polychromatic images. At certain patient-specific energy levels, corresponding to certain patient- and slice-dependent linear combination weights, e.g., E = 160 keV corresponds to α = 1.57, a significant reduction of metal artifacts may be observed. The authors aimed at analyzing the method for its artifact reduction capabilities to identify its limitations. The results are compared with raw data-based processing. METHODS: Clinical DECT uses a simplified version of monochromatic imaging by linearly combining the low and the high kV images and by assigning an energy to that linear combination. Those pseudo-monochromatic images can be used by radiologists to obtain images with reduced metal artifacts. The authors analyzed the underlying physics and carried out a series expansion of the polychromatic attenuation equations. The resulting nonlinear terms are responsible for the artifacts, but they are not linearly related between the low and the high kV scan: A linear combination of both images cannot eliminate the nonlinearities, it can only reduce their impact. Scattered radiation yields additional noncanceling nonlinearities. This method is compared to raw data-based artifact correction methods. To quantify the artifact reduction potential of pseudo-monochromatic images, they simulated the FORBILD abdomen phantom with metal implants, and they assessed patient data sets of a clinical dual source CT system (100, 140 kV Sn) containing artifacts induced by a highly concentrated contrast agent bolus and by metal. In each case, they manually selected an optimal α and compared it to a raw data-based material decomposition in case of simulation, to raw data-based material decomposition of inconsistent rays in case of the patient data set containing contrast agent, and to the frequency split normalized metal artifact reduction in case of the metal implant. For each case, the contrast-to-noise ratio (CNR) was assessed. RESULTS: In the simulation, the pseudo-monochromatic images yielded acceptable artifact reduction results. However, the CNR in the artifact-reduced images was more than 60% lower than in the original polychromatic images. In contrast, the raw data-based material decomposition did not significantly reduce the CNR in the virtual monochromatic images. Regarding the patient data with beam hardening artifacts and with metal artifacts from small implants the pseudo-monochromatic method was able to reduce the artifacts, again with the downside of a significant CNR reduction. More intense metal artifacts, e.g., as those caused by an artificial hip joint, could not be suppressed. CONCLUSIONS: Pseudo-monochromatic imaging is able to reduce beam hardening, scatter, and metal artifacts in some cases but it cannot remove them. In all cases, the CNR is significantly reduced, thereby rendering the method questionable, unless special post processing algorithms are implemented to restore the high CNR from the original images (e.g., by using a frequency split technique). Raw data-based dual energy decomposition methods should be preferred, in particular, because the CNR penalty is almost negligible.