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Dual energy CT angiography: pros and cons of dual-energy metal artifact reduction algorithm in patients after endovascular aortic repair

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Abstract

Purpose

To evaluate the value of metal artifact reduction (MAR) post-processing and iodine MD images in fast kV-switching dual-energy computed tomography (DECT) in patients after endovascular aortic repair (EVAR).

Materials and methods

Twenty-four consecutive EVAR patients (age 76 ± 9 years, 7/24 (29%) with coils, 9/24 (37.5%) with 10 endoleaks) who underwent DECT angiography were included in this HIPAA-compliant, IRB-approved retrospective study. Monochromatic reconstructions included 55, 60, 65, 70, and 75 keV with and without MAR and iodine MD images. Near field, far field, and vessel artifacts were assessed subjectively (1 = none; 5 = severe) and objectively by measuring noise and contrast-to-noise ratio. Visibility of endoleak was evaluated (1 = optimal; 5 = not visible).

Results

MAR objectively decreased artifacts from EVAR stents in the near field (60.7 ± 25.4 HU vs. 70.1 ± 34.2; p = .002) and subjectively increased near field (3.2 ± 0.9 vs. 2.8 ± 0.6; p < .001), far field (2.2 ± 0.6 vs. 1.6 ± 0.6; p < .001), and vessel (3.1 ± 1.1 vs. 2.5 ± 0.9; p < .001) artifacts. Near-field artifacts from coils were reduced by the MAR objectively (72.4 ± 24.8 vs. 182.7 ± 57.3 HU; p < .001) and subjectively (4.5 ± 0.5 vs. 4.9 ± 0.4; p = .02). CNR of standard reconstructions was optimal at 60 keV (38.3 ± 16.8). Reconstructions without MAR and iodine MD images provided improved endoleak visualization in 6/10 (60%) of cases (median 1 for both) compared to MAR (median 3) (p < 0.001). However, MAR improved visualization in 1/10 (10%) cases due to endoleak location adjacent to a coil.

Conclusion

DECT with MAR reduced artifacts from coils and improved endoleak visualization in 1/10 (10%) cases due to location adjacent to a coil. However, MAR impaired endoleak visualization in 6/10 (60%) cases and should be reviewed combined with 60 keV standard reconstructions and iodine MD images.

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Authors and Affiliations

  1. Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA

    Johannes Boos, Jieming Fang, Benedikt H. Heidinger, Vassilios Raptopoulos & Olga R. Brook

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  1. Johannes Boos
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  2. Jieming Fang
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  3. Benedikt H. Heidinger
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  4. Vassilios Raptopoulos
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  5. Olga R. Brook
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Corresponding author

Correspondence to Olga R. Brook.

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Funding

No funding was received for this study.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

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Written informed consent was waived by the IRB.

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Boos, J., Fang, J., Heidinger, B.H. et al. Dual energy CT angiography: pros and cons of dual-energy metal artifact reduction algorithm in patients after endovascular aortic repair. Abdom Radiol 42, 749–758 (2017). https://doi.org/10.1007/s00261-016-0973-7

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  • DOI: https://doi.org/10.1007/s00261-016-0973-7

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