The Impact of View- Angle Tilting and Slice Encoding for Metal Artifact Correction Methods on the Metal Artifact Reduction in Magnetic Resonance Imaging of the Knee Prosthesis

Purpose: At Magnetic Resonance Imaging (MRI), artifacts arising from metal implants are an obstacle to obtaining optimal images. This study aimed to evaluate the impact of View-Angle Tilting (VAT) and Slice Encoding for Metal Artifact Correction (SEMAC) techniques for the artifact reduction of patients during knee MRI with metal implants. Materials and Methods: The MR images without any intervention of the knee from 20 patients with knee prostheses were used. The VAT and SEMAC metal artifact reduction techniques were applied to all the MR images. Volume and mass of the metal prosthesis were quantified using the MATLAB program and compared with the real measurements using nonparametric Wilcoxon tests in SPSS software. The qualitative analysis was performed by two blinded observers regarding the score of artifact size, distortions, image quality, and visualization of bone marrow and soft tissues adjacent to metal implants. In addition, Cohen’s kappa values were used for inter-observer agreement. Results: The average volume of the platinum based on the conventional, VAT, and SEMAC methods was estimated at 14.22 ± 0.43, 14.05 ± 0.4, and 13.3 ± 0.45 cm3, respectively. The statistical analysis showed no significant difference (P > 0.05) between the mean value of the platinum volume for the SEMAC method and the real measurement (13.6 ± 0.33 cm3). Furthermore, regarding the conventional, VAT, and SEMAC sequences, the mean mass of the platinum was obtained at 305.02 ± 9.22, 301.37 ± 8.58, and 285.28 ± 9.65 g, respectively, with the P-Value of 0.005, 0.009, and 0.268, compared to the real measurements (286.81±8.75 g). Notably, the blinded readers demonstrated that the SEMAC method was remarkably superior quality compared with VAT and conventional acquisitions (P-Value< 0.05). Conclusion: The knee prosthesis metal artifact was reduced using the VAT and SEMAC techniques, in a way that, the reduction was significant by the SEMAC method. In addition, concerning the qualitative observer analysis, the application of the SEMAC technique provides improved visualization of tissue structures adjacent to metal implants.