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Combining monoenergetic extrapolations from dual-energy CT with iterative reconstructions: reduction of coil and clip artifacts from intracranial aneurysm therapy

  • Diagnostic Neuroradiology
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Abstract

Purpose

To compare and to combine iterative metal artifact reduction (MAR) and virtual monoenergetic extrapolations (VMEs) from dual-energy computed tomography (DECT) for reducing metal artifacts from intracranial clips and coils.

Methods

Fourteen clips and six coils were scanned in a phantom model with DECT at 100 and 150SnkVp. Four datasets were reconstructed: non-corrected images (filtered-back projection), iterative MAR, VME from DECT at 120 keV, and combined iterative MAR + VME images. Artifact severity scores and visibility of simulated, contrast-filled, adjacent vessels were assessed qualitatively and quantitatively by two independent, blinded readers.

Results

Iterative MAR, VME, and combined iterative MAR + VME resulted in a significant reduction of qualitative (p < 0.001) and quantitative clip artifacts (p < 0.005) and improved the visibility of adjacent vessels (p < 0.05) compared to non-corrected images, with lowest artifact scores found in combined iterative MAR + VME images. Titanium clips demonstrated less artifacts than Phynox clips (p < 0.05), and artifact scores increased with clip size. Coil artifacts increased with coil size but were reducible when applying iterative MAR + VME compared to non-corrected images. However, no technique improved the severe artifacts from large, densely packed coils.

Conclusions

Combining iterative MAR with VME allows for an improved metal artifact reduction from clips and smaller, loosely packed coils. Limited value was found for large and densely packed coils.

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Authors and Affiliations

  1. Department of Neuroradiology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland

    Sebastian Winklhofer, Gerasimos Baltsavias, Lars Michels & Antonios Valavanis

  2. Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland

    Ricarda Hinzpeter, Daniel Stocker & Hatem Alkadhi

  3. Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland

    Jan-Karl Burkhardt & Luca Regli

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  1. Sebastian Winklhofer
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Correspondence to Sebastian Winklhofer.

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Winklhofer, S., Hinzpeter, R., Stocker, D. et al. Combining monoenergetic extrapolations from dual-energy CT with iterative reconstructions: reduction of coil and clip artifacts from intracranial aneurysm therapy. Neuroradiology 60, 281–291 (2018). https://doi.org/10.1007/s00234-018-1981-9

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