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Metal artifact reduction for intracranial projectiles on post mortem computed tomography

Abstract : To compare the image quality of cranial post-mortem computed tomography (CT) obtained with and without projection-based single-energy metal artifact reduction (SEMAR) in cadavers with intracranial metallic ballistic projectiles. Materials and methods: From January 2017 to January 2018, cadavers with ballistic projectile head wounds with metal fragments and without massive head destruction were investigated using post-mortem CT. All subjects underwent CT using a conventional iterative reconstruction (IR) and SEMAR. To evaluate the impact of metallic artifacts, the total intracranial area (TA), non-interpretable zone (NIZ), disturbed interpretation zone (DZ), and artifact total surface (ATS) were delineated. Two independent readers identified extra-axial hemorrhage (EAH) and subarachnoid hemorrhage (SAH). Autopsy reports were used as the standard of reference. Results: Eleven corpses (10 males, 1 female; mean age, 62.8 ± 17.9 [SD] years) were evaluated. SEMAR showed a significant decrease in the ATS ratio with respect to conventional IR (72.1 ± 26.1 [SD] % [range: 26.8-99.1] vs. 86.4 ± 17.8 [SD] % [range: 37.2-100]; P < 0.001) and NIZ/TA ratios (11.6 ± 8.26% [range: 0.95-33.4] versus 42.5 ± 30.5% [range: 3.86-100]; P < 0.001). The interobserver reproducibility in diagnosing EAH and SAH was excellent with conventional IR (0.82) and good with SEMAR (0.75). SEMAR reduced uncertain diagnoses of EAH in 7 subjects for Reader 1 and in 6 for Reader 2, but did not influence the diagnosis of SAH for either reader. Conclusion: SEMAR reduces the influence of metallic artifacts and increases the confidence with which the diagnosis of EAH can be made on post-mortem CT.
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https://hal.univ-lorraine.fr/hal-03231120
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N. Douis, A.S. Formery, G. Hossu, L. Martrille, M. Kolopp, et al.. Metal artifact reduction for intracranial projectiles on post mortem computed tomography. Diagnostic and Interventional Imaging, Elsevier, 2020, 101 (3), pp.177-185. ⟨10.1016/j.diii.2019.10.009⟩. ⟨hal-03231120⟩

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