Metal Artifact Reduction for Orthopedic Implants (O-MAR): Usefulness in CT Evaluation of Reverse Total Shoulder Arthroplasty

Abstract

The objective of this study is to evaluate the effect of the metal artifact reduction algorithm for orthopedic implants (O-MAR) on CT image quality for patients with reverse total shoulder arthroplasty (RTSA), with emphasis placed on the evaluation of bone in the vicinity of prostheses. Sixty-five patients who underwent CT scanning after RTSA were enrolled in the study. Two radiologists analyzed the images reconstructed with filtered back projection (FBP) with or without O-MAR processing. Images were evaluated to determine the degree of streaking artifacts, the confidence in depicting various structures around the prosthesis, and the presence of pseudolesions. The mean CT number and SD of the selected ROIs placed in the greater tuberosity, glenoid bone, and deltoid muscle were recorded. For measurements from the greater tuberosity and glenoid bone, the frequency with which the measurement met the typical CT number of bone was calculated. O-MAR images showed less metal streak artifact and noise and provided better visualization of the axillary neurovascular bundle compared with FBP images, with a statistically significant difference (p < 0.001 for all). FBP images were found to be statistically significantly better than O-MAR images, offering better visualization of bone cortex, bone trabeculae, and the bone-prosthesis interface (p < 0.001 for all). Scapular pseudonotching was observed on 4.6% of FBP images and 36.9% of O-MAR images. The pseudocemented appearance was noted on 47.7% of O-MAR images but was not seen on FBP images. The use of O-MAR improved CT image quality for patients with RTSA in the aspect of metal artifact reduction and soft-tissue profile. However, O-MAR tends to degrade depiction of the bone trabeculae and bone cortex and generate new artifacts, including a pseudocemented appearance and scapular pseudonotching.