First experience with combined use of adaptive statistical iterative reconstruction and gemstone spectral imaging in spinal fusion CT images

Objective. To explore whether the image noises and the metal artifacts could be further managed by the combined use of two technologies, the adaptive statistical iterative reconstruction (ASIR) and the monochromatic imaging generated by gemstone spectral imaging (GSI) dual-energy CT. Materials and Methods. Fifty-one patients with 318 spinal pedicle screws were prospectively scanned with dual energy CT by using fast kV-switching GSI between 80 and 140 kVp. The monochromatic GSI images at 110 keV were reconstructed either without ASIR or with ASIR of various levels (30%, 50%, 70% and 100%). For these five sets of images, both objective and subjective image quality assessments were performed to evaluate the image quality. Results. With objective image quality assessment, the metal artifacts (measured by an artifacts index) significantly decreased when increasing levels of ASIR was utilized (p < 0.001). Moreover, adding ASIR to GSI also decreased the image noise (p < 0.001) and improved the signalto-noise ratio (SNR, p < 0.001). With subjective image quality analysis, the inter-reader agreements were good, with intra-class correlation coefficients (ICC) of 0.89 to 0.99. Meanwhile, the visualization of the peri-implant soft tissue was improved at higher ASIR levels (p < 0.001). Conclusion. Combined use of ASIR and GSI is shown to decrease the image noise and improve the image quality in post-spinal fusion CT scans. Optimal results were achieved with ASIR levels of over 70%.