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Original research
Beam hardening artifacts of liquid embolic agents: comparison between Squid and Onyx
  1. Raoul Pop1,2,
  2. Luc Mertz3,
  3. Annamaria Ilyes1,
  4. Dan Mihoc1,
  5. Johann Sebastian Richter1,
  6. Monica Manisor1,
  7. Stéphane Kremer4,
  8. Rémy Beaujeux1,2
  1. 1 Interventional Neuroradiology Department, Strasbourg University Hospitals, Strasbourg, France
  2. 2 Institut Hopitalo-Universitaire Strasbourg, Strasbourg, France
  3. 3 Medical Physics Department, Strasbourg University Hospitals, Strasbourg, France
  4. 4 Neuroradiology Department, Imagerie 2, Strasbourg University Hospitals, Strasbourg, France
  1. Correspondence to Dr Raoul Pop, Service de Neuroradiologie Interventionnelle, Hôpital de Hautepierre, Strasbourg 67091, France; pop.raoul{at}gmail.com

Abstract

Background Initial clinical experience with Squid shows subjectively reduced artifacts on post-embolization CT scans compared with Onyx. To further investigate these observations, we aimed to perform a comparison of artifacts between Squid and Onyx in a controlled in vitro model.

Materials and methods Onyx 18 and all four variants of Squid (Squid 18, Squid 18 low density (LD), Squid 12, Squid 12 LD) were each injected in dimethylsulfoxide (DMSO) compatible test tubes. The tubes containing precipitated embolic material were inserted in a CT phantom for conventional and flat panel CT acquisitions. Beam hardening artifacts were quantified using objective and subjective measurements.

Results Objective evaluation of artifacts within regions of interest (ROIs) placed around the embolic material on CT and flat panel CT images demonstrated significantly lower noise and Hounsfield unit (HU) range values for all four Squid products compared with Onyx 18. On both CT and flat panel CT, LD variants of Squid 18 and Squid 12 had significantly lower noise and HU range values than their normal density counterparts on longitudinal ROIs. When using subjective measures for diagnostic value within ROIs placed around the embolic material on both CT and flat panel CT images, the number of non-diagnostic ROIs was significantly higher for Onyx 18 than for all four Squid variants.

Conclusion All four variants of Squid induced fewer beam hardening artifacts than Onyx 18 on CT and flat panel CT acquisitions. LD variants of Squid induced fewer artifacts than their normal density counterparts.

  • arteriovenous malformation
  • ct
  • liquid embolic material
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Footnotes

  • Twitter @RaoulPop25

  • Contributors RP: conception or design of the work; acquisition, analysis, and interpretation of the data; drafting the work; final approval of the version to be published; and agreement to be accountable for all aspects of the work. LM: conception or design of the work; analysis and interpretation of the data; revision of the paper for important intellectual content; final approval of the version to be published; and agreement to be accountable for all aspects of the work. AI: acquisition of the data; analysis of the data; revision of the paper for important intellectual content; final approval of the version to be published; and agreement to be accountable for all aspects of the work. DM: acquisition of the data; revision of the paper for important intellectual content; final approval of the version to be published; and agreement to be accountable for all aspects of the work. JSR: acquisition of the data; revision of the paper for important intellectual content; final approval of the version to be published; and agreement to be accountable for all aspects of the work. MM: acquisition of the data; revision of the paper for important intellectual content; final approval of the version to be published; and agreement to be accountable for all aspects of the work. SK: analysis and interpretation of the data; revision of the paper for important intellectual content; final approval of the version to be published; and agreement to be accountable for all aspects of the work. RB: conception or design of the work; interpretation of the data; revision of the paper for important intellectual content; final approval of the version to be published; and agreement to be accountable for all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.

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