The value of iterative metal artifact reduction algorithms during antenna positioning for CT-guided microwave ablation

Abstract

Objectives: To compare image quality between filtered back projection (FBP) and iterative reconstruction algorithm and dedicated metal artifact reduction (iMAR) algorithms during antenna positioning for computed tomography-guided microwave ablation (MWA).

Materials and methods: An MWA antenna was positioned in the liver of five pigs under CT guidance. Different exposure settings (120kV_p/200mAs-120kV_p/50mAs) and image reconstruction techniques (FBP, iterative reconstruction with and without iMAR) were applied. Quantitative image analysis included density measurements in six positions (e.g., liver in extension of the antenna [ANTENNA] and liver >3 cm away from the antenna [LIVER-1]). Qualitative image analysis included assessment of overall quality, image noise, artifacts at the antenna tip, artifacts in liver parenchyma bordering antenna tip and newly generated artifacts. Two independent observers performed the analyses twice and interreader agreement was compared with Bland–Altman analysis.

Results: For all exposure and reconstruction settings, density measurements for ANTENNA were significantly higher for the I30-1 iMAR compared with FBP and I30-1 (e.g., 8.3−17.2HU vs. −104.5 to 155.1HU; p ≤ 0.01, respectively). In contrast, for all exposure settings, density measurements for LIVER-1 were comparable between FBP and I30-1 iMAR (e.g., 49.4−50.4HU vs. 50.1−52.5U, respectively). For all exposure and reconstruction settings, subjective image quality for LIVER-1 was better for the I30-1 iMAR algorithm compared with FBP and I30-1. Bland–Altman interobserver agreement was from −0.2 to 0.2 for FBP and iMAR, and Cohen’s kappa was 0.74.

Conclusion: Iterative algorithms I30-1 with iMAR algorithm improves image quality during antenna positioning and placement for CT-guided MWA and is applicable over a range of exposure settings.

Keywords:

• Iterative metal artifact reduction
• computed tomography
• image quality
• microwave ablation
• CT-guidance

Acknowledgments

This study was supported technically by Medtronic Covidien, Mansfield, MA, USA.

Ethical approval

The study was performed according to rules outlined by the local and governmental animal care committee instituted by the German government. The ethics committee approved this study as a part of other trials.

Disclosure statement

The corresponding author declares that all authors have read the manuscript and gave permission to submit the work in its current version. All authors have made substantial contributions to conception and design of the study, or acquisition data, or analysis and interpretation of data; drafting the article or revising it.

Additional information

Funding

Thuy Duong Do was supported by a grant from the Medical Faculty of the University of Heidelberg.