Top

Published in:

01-03-2018 | Diagnostic Neuroradiology

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

Authors: Sebastian Winklhofer, Ricarda Hinzpeter, Daniel Stocker, Gerasimos Baltsavias, Lars Michels, Jan-Karl Burkhardt, Luca Regli, Antonios Valavanis, Hatem Alkadhi

Published in: Neuroradiology | Issue 3/2018

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.

van Rooij WJ, Sluzewski M (2009) Opinion: imaging follow-up after coiling of intracranial aneurysms. AJNR Am J Neuroradiol 30(9):1646–1648. https://doi.org/10.3174/ajnr.A1673 CrossRefPubMed

Li H, Pan R, Wang H, Rong X, Yin Z, Milgrom DP, Shi X, Tang Y, Peng Y (2013) Clipping versus coiling for ruptured intracranial aneurysms: a systematic review and meta-analysis. Stroke 44(1):29–37. https://doi.org/10.1161/STROKEAHA.112.663559 CrossRefPubMed

Psychogios MN, Scholz B, Rohkohl C, Kyriakou Y, Mohr A, Schramm P, Wachter D, Wasser K, Knauth M (2013) Impact of a new metal artefact reduction algorithm in the noninvasive follow-up of intracranial clips, coils, and stents with flat-panel angiographic CTA: initial results. Neuroradiology 55(7):813–818. https://doi.org/10.1007/s00234-013-1165-6 CrossRefPubMed

Wallace RC, Karis JP, Partovi S, Fiorella D (2007) Noninvasive imaging of treated cerebral aneurysms, part II: CT angiographic follow-up of surgically clipped aneurysms. AJNR Am J Neuroradiol 28(7):1207–1212. https://doi.org/10.3174/ajnr.A0664 CrossRefPubMed

Kaufmann TJ, Huston J 3rd, Mandrekar JN, Schleck CD, Thielen KR, Kallmes DF (2007) Complications of diagnostic cerebral angiography: evaluation of 19,826 consecutive patients. Radiology 243(3):812–819. https://doi.org/10.1148/radiol.2433060536 CrossRefPubMed

Jiang L, He ZH, Zhang XD, Lin B, Yin XH, Sun XC (2011) Value of noninvasive imaging in follow-up of intracranial aneurysm. Acta Neurochir Suppl 110(Pt 2):227–232. https://doi.org/10.1007/978-3-7091-0356-2_41 PubMed

Sagara Y, Kiyosue H, Hori Y, Sainoo M, Nagatomi H, Mori H (2005) Limitations of three-dimensional reconstructed computerized tomography angiography after clip placement for intracranial aneurysms. J Neurosurg 103(4):656–661. https://doi.org/10.3171/jns.2005.103.4.0656 CrossRefPubMed

Buhk JH, Kallenberg K, Mohr A, Dechent P, Knauth M (2009) Evaluation of angiographic computed tomography in the follow-up after endovascular treatment of cerebral aneurysms—a comparative study with DSA and TOF-MRA. Eur Radiol 19(2):430–436. https://doi.org/10.1007/s00330-008-1171-y CrossRefPubMed

Kovacs A, Flacke S, Tschampa H, Hadizadeh D, Greschus S, Clusmann H, Kristof R, Urbach H (2010) Gated multidetector computed tomography. A technique to reduce intracranial aneurysm clip and coil artifacts. Clin Neuroradiol 20(2):99–107. https://doi.org/10.1007/s00062-010-0001-1 CrossRefPubMed

10.

van der Schaaf I, van Leeuwen M, Vlassenbroek A, Velthuis B (2006) Minimizing clip artifacts in multi CT angiography of clipped patients. AJNR Am J Neuroradiol 27(1):60–66PubMed

11.

De Crop A, Casselman J, Van Hoof T, Dierens M, Vereecke E, Bossu N, Pamplona J, D'Herde K, Thierens H, Bacher K (2015) Analysis of metal artifact reduction tools for dental hardware in CT scans of the oral cavity: kVp, iterative reconstruction, dual-energy CT, metal artifact reduction software: does it make a difference? Neuroradiology 57(8):841–849. https://doi.org/10.1007/s00234-015-1537-1 CrossRefPubMed

12.

Meyer E, Raupach R, Lell M, Schmidt B, Kachelriess M (2010) Normalized metal artifact reduction (NMAR) in computed tomography. Med Phys 37(10):5482–5493. https://doi.org/10.1118/1.3484090 CrossRefPubMed

13.

Meyer E, Raupach R, Lell M, Schmidt B, Kachelriess M (2012) Frequency split metal artifact reduction (FSMAR) in computed tomography. Med Phys 39(4):1904–1916. https://doi.org/10.1118/1.3691902 CrossRefPubMed

14.

Morsbach F, Wurnig M, Kunz DM, Krauss A, Schmidt B, Kollias SS, Alkadhi H (2013) Metal artefact reduction from dental hardware in carotid CT angiography using iterative reconstructions. Eur Radiol 23(10):2687–2694. https://doi.org/10.1007/s00330-013-2885-z CrossRefPubMed

15.

Bamberg F, Dierks A, Nikolaou K, Reiser MF, Becker CR, Johnson TR (2011) Metal artifact reduction by dual energy computed tomography using monoenergetic extrapolation. Eur Radiol 21(7):1424–1429. https://doi.org/10.1007/s00330-011-2062-1 CrossRefPubMed

16.

Winklhofer S, Benninger E, Spross C, Morsbach F, Rahm S, Ross S, Jost B, Thali MJ, Stolzmann P, Alkadhi H, Guggenberger R (2014) CT metal artefact reduction for internal fixation of the proximal humerus: value of mono-energetic extrapolation from dual-energy and iterative reconstructions. Clin Radiol 69(5):e199–e206. https://doi.org/10.1016/j.crad.2013.12.011 CrossRefPubMed

17.

Bier G, Bongers MN, Hempel JM, Orgel A, Hauser TK, Ernemann U, Hennersdorf F (2017) Follow-up CT and CT angiography after intracranial aneurysm clipping and coiling-improved image quality by iterative metal artifact reduction. Neuroradiology 59(7):649–654. https://doi.org/10.1007/s00234-017-1855-6 CrossRefPubMed

18.

Dunet V, Bernasconi M, Hajdu SD, Meuli RA, Daniel RT, Zerlauth JB (2017) Impact of metal artifact reduction software on image quality of gemstone spectral imaging dual-energy cerebral CT angiography after intracranial aneurysm clipping. Neuroradiology 59(9):845–852. https://doi.org/10.1007/s00234-017-1871-6 CrossRefPubMed

19.

Dolati P, Eichberg D, Wong JH, Goyal M (2015) The utility of dual-energy computed tomographic angiography for the evaluation of brain aneurysms after surgical clipping: a prospective study. World Neurosurg 84(5):1362–1371. https://doi.org/10.1016/j.wneu.2015.06.027 CrossRefPubMed

20.

Jia Y, Zhang J, Fan J, Li C, Sun Y, Li D, Xiao X (2015) Gemstone spectral imaging reduced artefacts from metal coils or clips after treatment of cerebral aneurysms: a retrospective study of 35 patients. Br J Radiol 88(1055):20150222. https://doi.org/10.1259/bjr.20150222 CrossRefPubMedPubMedCentral

21.

Higashigaito K, Angst F, Runge VM, Alkadhi H, Donati OF (2015) Metal artifact reduction in pelvic computed tomography with hip prostheses: comparison of virtual monoenergetic extrapolations from dual-energy computed tomography and an iterative metal artifact reduction algorithm in a phantom study. Investig Radiol 50(12):828–834. https://doi.org/10.1097/RLI.0000000000000191 CrossRef

22.

Morsbach F, Bickelhaupt S, Wanner GA, Krauss A, Schmidt B, Alkadhi H (2013) Reduction of metal artifacts from hip prostheses on CT images of the pelvis: value of iterative reconstructions. Radiology 268(1):237–244. https://doi.org/10.1148/radiol.13122089 CrossRefPubMed

23.

Guggenberger R, Winklhofer S, Osterhoff G, Wanner GA, Fortunati M, Andreisek G, Alkadhi H, Stolzmann P (2012) Metallic artefact reduction with monoenergetic dual-energy CT: systematic ex vivo evaluation of posterior spinal fusion implants from various vendors and different spine levels. Eur Radiol 22(11):2357–2364. https://doi.org/10.1007/s00330-012-2501-7 CrossRefPubMed

24.

Meinel FG, Bischoff B, Zhang Q, Bamberg F, Reiser MF, Johnson TR (2012) Metal artifact reduction by dual-energy computed tomography using energetic extrapolation: a systematically optimized protocol. Investig Radiol 47(7):406–414. https://doi.org/10.1097/RLI.0b013e31824c86a3 CrossRef

25.

Lane BF, Vandermeer FQ, Oz RC, Irwin EW, McMillan AB, Wong-You-Cheong JJ (2011) Comparison of sagittal T2-weighted BLADE and fast spin-echo MRI of the female pelvis for motion artifact and lesion detection. AJR Am J Roentgenol 197(2):W307–W313. https://doi.org/10.2214/AJR.10.5918 CrossRefPubMed

26.

Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33(1):159–174. https://doi.org/10.2307/2529310 CrossRefPubMed

27.

Kirkwood BR, Sterne JAC, Kirkwood BR (2003) Essential medical statistics, 2nd edn. Blackwell Science, Malden

28.

van Loon JJ, Yousry TA, Fink U, Seelos KC, Reulen HJ, Steiger HJ (1997) Postoperative spiral computed tomography and magnetic resonance angiography after aneurysm clipping with titanium clips. Neurosurgery 41(4):851–856; discussion 856-857. https://doi.org/10.1097/00006123-199710000-00016 CrossRefPubMed

29.

Wang F, Zhang Y, Xue H, Han W, Yang X, Jin Z, Zwar R (2017) Combined use of iterative reconstruction and monochromatic imaging in spinal fusion CT images. Acta Radiol 58(1):62–69. https://doi.org/10.1177/0284185116631182 CrossRefPubMed

30.

Bongers MN, Schabel C, Thomas C, Raupach R, Notohamiprodjo M, Nikolaou K, Bamberg F (2015) Comparison and combination of dual-energy- and iterative-based metal artefact reduction on hip prosthesis and dental implants. PLoS One 10(11):e0143584. https://doi.org/10.1371/journal.pone.0143584 CrossRefPubMedPubMedCentral

31.

Hegde A, Chan LL, Tan L, Illyyas M, Lim WE (2009) Dual energy CT and its use in neuroangiography. Ann Acad Med Singap 38(9):817–820PubMed

32.

Bakker NA, Westerlaan HE, Metzemaekers JD, van Dijk JM, Eshghi OS, Mooij JJ, Groen RJ (2010) Feasibility of magnetic resonance angiography (MRA) follow-up as the primary imaging modality after coiling of intracranial aneurysms. Acta Radiol 51(2):226–232. https://doi.org/10.3109/02841850903436642 CrossRefPubMed

33.

Abdulazim A, Rubbert C, Reichelt D, Mathys C, Turowski B, Steiger HJ, Hanggi D, Etminan N (2017) Dual- versus single-energy CT-angiography imaging for patients undergoing intracranial aneurysm repair. Cerebrovasc Dis 43(5–6):272–282. https://doi.org/10.1159/000464356 CrossRefPubMed

34.

Steiner T, Juvela S, Unterberg A, Jung C, Forsting M, Rinkel G, European Stroke O (2013) European stroke organization guidelines for the management of intracranial aneurysms and subarachnoid haemorrhage. Cerebrovasc Dis 35(2):93–112. https://doi.org/10.1159/000346087 CrossRefPubMed

35.

Pechlivanis I, Harders A, Tuttenberg J, Barth M, Schulte-Altedorneburg G, Schmieder K (2009) Computed tomographic angiography: diagnostic procedure of choice in the management of subarachnoid hemorrhage in the elderly patient? Cerebrovasc Dis 28(5):481–489. https://doi.org/10.1159/000236526 CrossRefPubMed

36.

van der Jagt M, Flach HZ, Tanghe HL, Bakker SL, Hunink MG, Koudstaal PJ, van der Lugt A (2008) Assessment of feasibility of endovascular treatment of ruptured intracranial aneurysms with 16-detector row CT angiography. Cerebrovasc Dis 26(5):482–488. https://doi.org/10.1159/000155985 CrossRefPubMed

Title: Combining monoenergetic extrapolations from dual-energy CT with iterative reconstructions: reduction of coil and clip artifacts from intracranial aneurysm therapy
Authors: Sebastian Winklhofer
Ricarda Hinzpeter
Daniel Stocker
Gerasimos Baltsavias
Lars Michels
Jan-Karl Burkhardt
Luca Regli
Antonios Valavanis
Hatem Alkadhi
Publication date: 01-03-2018
Publisher: Springer Berlin Heidelberg
Published in: Neuroradiology / Issue 3/2018
Print ISSN: 0028-3940
Electronic ISSN: 1432-1920
DOI: https://doi.org/10.1007/s00234-018-1981-9

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

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

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 3/2018

The T1 shine through effect on susceptibility weighted imaging: an under recognized phenomenon

Alteration of putaminal fractional anisotropy in Parkinson’s disease: a longitudinal diffusion kurtosis imaging study

A method for pre-operative single-subject thalamic segmentation based on probabilistic tractography for essential tremor deep brain stimulation

MRI findings in glutamic acid decarboxylase associated autoimmune epilepsy

Reducing task-based fMRI scanning time using simultaneous multislice echo planar imaging

Increased variability of watershed areas in patients with high-grade carotid stenosis