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Case series
Separating the wheat from the chaff: region of interest combined with metal artifact reduction for completion angiography following cerebral aneurysm treatment
  1. Edward A M Duckworth1,2,3,
  2. Chris Nickele2,3,
  3. Sebastian Schafer4,
  4. Sebastian Bauer4,
  5. Bernhard Scholz4,
  6. Lucas Elijovich2,3,5,
  7. Daniel Hoit2,3,
  8. Vinodh T Doss2,3,5,
  9. Adam S Arthur2,3
  1. 1Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
  2. 2Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA
  3. 3Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA
  4. 4Siemens Medical Solutions USA, Hoffman Estates, Illinois, USA
  5. 5Department of Neurology, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA
  1. Correspondence to Dr A S Arthur, Department of Neurosurgery, University of Tennessee Health Sciences Center, Semmes-Murphey Neurologic and Spine Institute, 6325 Humphreys Blvd, Memphis, TN 38120, USA; aarthur{at}


Introduction Following complicated endovascular or microsurgical treatments, assessment of radiographic outcome can be challenging due to device resolution and metallic artifact. Two-dimensional and three-dimensional angiography can reveal information about flow and aneurysm obliteration, but may be limited by beam hardening, overlapping vessels, and image degradation in the region of metallic implants. In this study, we investigated the combination of a collimated volumetric imaging (volume of interest, VOI) protocol followed by metal artifact reduction (MAR) post-processing to evaluate the correct positioning of stents, flow diverters, coils, and clips while limiting the radiation dose to the patient.

Methods 9 patients undergoing 10 procedures were included in our study. All patients underwent endovascular or surgical treatment of a cerebral aneurysm involving stents, flow diverting stents, coils, and/or clips followed by either immediate or early postoperative evaluation of our protocol.

Results Image datasets corrected for metallic artifacts (VOI-MAR) were judged to be better—a statistically significant finding—than image datasets only corrected for field of view truncation (VOI alone). Qualitatively, images were more interpretable and informative with regards to device position and apposition to the vessel wall for those cases involving a pipeline, and with regards to encroachment on the parent artery and possible residual aneurysm, in all cases.

Conclusions VOI acquisition combined with MAR post-processing provides for accurate and informative evaluation of cerebral aneurysm treatment while limiting the radiation dose to patients.

  • Angiography
  • Aneurysm
  • Coil

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  • Contributors All authors of this work met ICMJE criteria for authorship and made substantial contributions to the conception and design, acquisition of the data, analysis and interpretation of the data, drafting, critical revising, and final approval of this manuscript.

  • Competing interests SS, SB, and BS are employees of Siemens Medical Solutions USA. LE has served as a consultant for Stryker Neurovascular, Microvention, and Codman Neurovascular. VTH has served as a consultant for Covidien. ASA has served as a consultant for Covidien, Johnson and Johnson, Siemens, Stryker, and Terumo, and received grants from Siemens and Terumo.

  • Ethics approval The study was approved by the institutional review board of the University of Tennessee HSC.

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