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Neuroimaging
Original research
Metal artifact reduction for flat panel detector intravenous CT angiography in patients with intracranial metallic implants after endovascular and surgical treatment
  1. Rastislav Pjontek1,
  2. Belgin Önenköprülü1,
  3. Bernhard Scholz2,
  4. Yiannis Kyriakou2,
  5. Gerrit A Schubert3,
  6. Omid Nikoubashman1,4,
  7. Ahmed Othman1,
  8. Martin Wiesmann1,
  9. Marc A Brockmann1
  1. 1Department of Diagnostic and Interventional Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
  2. 2Healthcare, Imaging & Therapy Division, Siemens AG, Forchheim, Germany
  3. 3Department of Neurosurgery, University Hospital RWTH Aachen, Aachen, Germany
  4. 4Institute of Neuroscience and Medicine 4, Medical Imaging Physics, Forschungszentrum Jülich, Jülich, Germany
  1. Correspondence to Professor Marc A Brockmann, Department of Diagnostic and Interventional Neuroradiology, University Hospital RWTH Aachen, Pauwelsstr 30, Aachen 52074, Germany; brockmann{at}gmx.de

Abstract

Background Flat panel detector CT angiography with intravenous contrast agent injection (IV CTA) allows high-resolution imaging of cerebrovascular structures. Artifacts caused by metallic implants like platinum coils or clips lead to degradation of image quality and are a significant problem.

Objective To evaluate the influence of a prototype metal artifact reduction (MAR) algorithm on image quality in patients with intracranial metallic implants.

Methods Flat panel detector CT after intravenous application of 80 mL contrast agent was performed with an angiography system (Artis zee; Siemens, Forchheim, Germany) using a 20 s rotation protocol (200° rotation angle, 20 s acquisition time, 496 projections). The data before and after MAR of 26 patients with a total of 34 implants (coils, clips, stents) were independently evaluated by two blinded neuroradiologists.

Results MAR improved the assessability of the brain parenchyma and small vessels (diameter <1 mm) in the neighborhood of metallic implants and at a distance of 6 cm (p<0.001 each, Wilcoxon test). Furthermore, MAR significantly improved the assessability of parent vessel patency and potential aneurysm remnants (p<0.005 each, McNemar test). MAR, however, did not improve assessability of stented vessels.

Conclusions When an intravenous contrast protocol is used, MAR significantly ameliorates the assessability of brain parenchyma, vessels, and treated aneurysms in patients with intracranial coils or clips.

  • CT Angiography
  • CT
  • Technology

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/neurintsurg-2015-011787

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