Periprosthetic Artifact Reduction Using Virtual Monochromatic Imaging Derived From Gemstone Dual-Energy Computed Tomography and Dedicated Software.

The aim of this study was to explore the usefulness of combined virtual monochromatic imaging and metal artifact reduction software (MARS) for the evaluation of musculoskeletal periprosthetic tissue.Measurements were performed in periprosthetic and remote regions in 80 patients using a high-definition scanner. Polychromatic images with and without MARS and virtual monochromatic images were obtained.Periprosthetic polychromatic imaging (PI) showed significant differences compared with remote areas among the 3 tissues explored (P < 0.0001). No significant differences were observed between periprosthetic and remote tissues using monochromatic imaging with MARS (P = 0.053 bone, P = 0.32 soft tissue, and P = 0.13 fat). However, such differences were significant using PI with MARS among bone (P = 0.005) and fat (P = 0.02) tissues. All periprosthetic areas were noninterpretable using PI, compared with 11 (9%) using monochromatic imaging.The combined use of virtual monochromatic imaging and MARS reduced periprosthetic artifacts, achieving attenuation levels comparable to implant-free tissue.