The Value of Metal Artifact Reduction and Iterative Algorithms in Dual Energy CT Angiography in Patients After Complex Endovascular Aortic Aneurysm Repair

Overview

Journal Heliyon

Specialty Social Sciences

Date 2023 Oct 25

PMID 37876478

Authors

Wojciech Kazimierczak

Ewa Nowak

Natalia Kazimierczak

Tomasz Jankowski

Agnieszka Jankowska

Zbigniew Serafin

Affiliations

Soon will be listed here.

Abstract

Rationale And Objectives: Evaluation of the diagnostic value of linearly blended (LB) and virtual monoenergetic images (VMI) reconstruction techniques with and without metal artifacts reduction (MAR) and of adaptive statistical iterative reconstructions (ASIR) in the assessment of target vessels after branched/fenestrated endovascular aortic repair (f/brEVAR) procedures.

Materials And Methods: CT scans of 28 patients were used in this study. Arterial phase of examination was obtained using a dual-energy fast-kVp switching scanner. CT numbers in the aorta, celiac trunk, superior mesenteric artery, and renal arteries were measured in the following reconstructions: LB, VMI 60 keV, VMI MAR 60 keV, VMI ASIR 60 % 60 keV. Contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR) were calculated for each reconstruction. Luminal diameters (measurements at 2 levels of stent) and subjective image quality (5-point Likert scale) were assessed (2 readers, blinded to the type of reconstruction).

Results: The highest mean values of CNR and SNR in vascular structures were obtained in VMI MAR 60 keV (CNR 12.526 ± 2.46, SNR 17.398 ± 2.52), lower in VMI 60 keV (CNR 11.508 ± 2.01, SNR 16.524 ± 2.07) and VMI ASIR (CNR 11.086 ± 1.78, SNR 15.928 ± 1.82), and the lowest in LB (CNR 6.808 ± 0.79, SNR 11.492 ± 0.79) reconstructions. There were no statistically significant differences in the measurements of the stent width between reconstructions (p > 0.05). The highest subjective image quality was obtained in the ASIR VMI (4.25 ± 0.44) and the lowest in the MAR VMI (1.57 ± 0.5) reconstruction.

Conclusion: Despite obtaining the highest values of SNR and CNR in the MAR VMI reconstruction, the subjective diagnostic value was the lowest for this technique due to significant artifacts. The type of reconstruction did not significantly affect vessel diameter measurements (p > 0.05). Iterative reconstructions raised both objective and subjective image quality.

Citing Articles

Effectiveness of single-energy metal artifact reduction algorithm in CT: application to contrast-enhanced CT with EVAR and coil embolization.

Mochizuki J, Oyama-Manabe N, Kato F, Takahashi H, Manabe O, Sawada A Int J Cardiovasc Imaging. 2025; 41(2):369-376.

PMID: 39825071 DOI: 10.1007/s10554-024-03318-1.

Monoenergetic reconstructions and iodine density maps for visualization of coronary artery stents using 8-cm dual-layer detector spectral computed tomography: an phantom study.

Chen L, Pan N, Hu B, Li Y, Dong S, Zhou Y Quant Imaging Med Surg. 2024; 14(10):7671-7683.

PMID: 39429615 PMC: 11485354. DOI: 10.21037/qims-24-786.

Assessing the diagnostic accuracy of artificial intelligence in post-endovascular aneurysm repair endoleak detection using dual-energy computed tomography angiography.

Nowak E, Bialecki M, Bialecka A, Kazimierczak N, Kloska A Pol J Radiol. 2024; 89:e420-e427.

PMID: 39257927 PMC: 11384217. DOI: 10.5114/pjr/192115.

Performance of different cone-beam computed tomography scan modes with and without metal artifact reduction in detection of recurrent dental caries under various restorative materials.

Abesi F, Talachi F, Ezoji F Pol J Radiol. 2024; 89:e281-e291.

PMID: 39040560 PMC: 11262014. DOI: 10.5114/pjr/188257.

Angle Dependence of Electrode Lead-Related Artifacts in Single- and Dual-Energy Cardiac ECG-Gated CT Scanning-A Phantom Study.

Tarkowski P, Siek E, Staskiewicz G, Bielecki D, Czekajska-Chehab E J Clin Med. 2024; 13(13).

PMID: 38999312 PMC: 11242805. DOI: 10.3390/jcm13133746.

References

Ragusi M, van der Meer R, Joemai R, van Schaik J, van Rijswijk C . Evaluation of CT Angiography Image Quality Acquired with Single-Energy Metal Artifact Reduction (SEMAR) Algorithm in Patients After Complex Endovascular Aortic Repair. Cardiovasc Intervent Radiol. 2017; 41(2):323-329. PMC: 5758681. DOI: 10.1007/s00270-017-1812-0. View

Grimme F, Zeebregts C, Verhoeven E, Bekkema F, Reijnen M, Tielliu I . Visceral stent patency in fenestrated stent grafting for abdominal aortic aneurysm repair. J Vasc Surg. 2013; 59(2):298-306. DOI: 10.1016/j.jvs.2013.08.005. View

Zopfs D, Lennartz S, Pennig L, Glauner A, Abdullayev N, Bremm J . Virtual monoenergetic images and post-processing algorithms effectively reduce CT artifacts from intracranial aneurysm treatment. Sci Rep. 2020; 10(1):6629. PMC: 7170914. DOI: 10.1038/s41598-020-63574-8. View

DAngelo T, Vizzari G, Lanzafame L, Pergolizzi F, Mazziotti S, Gaeta M . Spectral CT Imaging of Prosthetic Valve Embolization after Transcatheter Aortic Valve Implantation. Diagnostics (Basel). 2023; 13(4). PMC: 9955456. DOI: 10.3390/diagnostics13040678. View

van Hedent S, Grosse Hokamp N, Kessner R, Gilkeson R, Ros P, Gupta A . Effect of Virtual Monoenergetic Images From Spectral Detector Computed Tomography on Coronary Calcium Blooming. J Comput Assist Tomogr. 2018; 42(6):912-918. DOI: 10.1097/RCT.0000000000000811. View

Grant K, Flohr T, Krauss B, Sedlmair M, Thomas C, Schmidt B . Assessment of an advanced image-based technique to calculate virtual monoenergetic computed tomographic images from a dual-energy examination to improve contrast-to-noise ratio in examinations using iodinated contrast media. Invest Radiol. 2014; 49(9):586-92. DOI: 10.1097/RLI.0000000000000060. View

William Stavropoulos S, Marin H, Fairman R, Carpenter J, Litt H, Itkin M . Recurrent endoleak detection and measurement of aneurysm size with CTA after coil embolization of endoleaks. J Vasc Interv Radiol. 2005; 16(10):1313-7. DOI: 10.1097/01.RVI.0000175900.61777.9A. View

Wayer D, Kim N, Otto B, Grayev A, Kuner A . Unintended Consequences: Review of New Artifacts Introduced by Iterative Reconstruction CT Metal Artifact Reduction in Spine Imaging. AJNR Am J Neuroradiol. 2019; 40(11):1973-1975. PMC: 6975108. DOI: 10.3174/ajnr.A6238. View

Kazimierczak W, Kazimierczak N, Lemanowicz A, Nowak E, Migdalski A, Jawien A . Improved Detection of Endoleaks in Virtual Monoenergetic Images in Dual-Energy CT Angiography Following EVAR. Acad Radiol. 2023; 30(12):2813-2824. DOI: 10.1016/j.acra.2023.03.018. View

10.

Monti C, Zanardo M, Cozzi A, Schiaffino S, Spagnolo P, Secchi F . Dual-energy CT performance in acute pulmonary embolism: a meta-analysis. Eur Radiol. 2021; 31(8):6248-6258. DOI: 10.1007/s00330-020-07633-8. View

11.

De Cecco C, Darnell A, Rengo M, Muscogiuri G, Bellini D, Ayuso C . Dual-energy CT: oncologic applications. AJR Am J Roentgenol. 2012; 199(5 Suppl):S98-S105. DOI: 10.2214/AJR.12.9207. View

12.

Michalska M, Kazimierczak W, Leszczynski W, Nadolska K, Bryl L . Contemporary follow-up imaging after endovascular repair of lower extremity atherosclerotic lesions. Pol J Radiol. 2019; 83:e634-e642. PMC: 6384408. DOI: 10.5114/pjr.2018.80348. View

13.

Sudarski S, Apfaltrer P, Nance Jr J, Schneider D, Meyer M, Schoenberg S . Optimization of keV-settings in abdominal and lower extremity dual-source dual-energy CT angiography determined with virtual monoenergetic imaging. Eur J Radiol. 2013; 82(10):e574-81. DOI: 10.1016/j.ejrad.2013.04.040. View

14.

Singh S, Kalra M, Hsieh J, Licato P, Do S, Pien H . Abdominal CT: comparison of adaptive statistical iterative and filtered back projection reconstruction techniques. Radiology. 2010; 257(2):373-83. DOI: 10.1148/radiol.10092212. View

15.

DAngelo T, Bucher A, Lenga L, Arendt C, Peterke J, Caruso D . Optimisation of window settings for traditional and noise-optimised virtual monoenergetic imaging in dual-energy computed tomography pulmonary angiography. Eur Radiol. 2017; 28(4):1393-1401. DOI: 10.1007/s00330-017-5059-6. View

16.

DAngelo T, Lenga L, Arendt C, Bucher A, Peterke J, Caruso D . Carotid and cerebrovascular dual-energy computed tomography angiography: Optimization of window settings for virtual monoenergetic imaging reconstruction. Eur J Radiol. 2020; 130:109166. DOI: 10.1016/j.ejrad.2020.109166. View

17.

DAngelo T, Cicero G, Mazziotti S, Ascenti G, Albrecht M, Martin S . Dual energy computed tomography virtual monoenergetic imaging: technique and clinical applications. Br J Radiol. 2019; 92(1098):20180546. PMC: 6592074. DOI: 10.1259/bjr.20180546. View

18.

Gruschwitz P, Petritsch B, Schmid A, Schmidt A, Grunz J, Kuhl P . Noise-optimized virtual monoenergetic reconstructions of dual-energy CT angiographies improve assessability of the lower leg arterial segments in peripheral arterial occlusive disease. Radiography (Lond). 2022; 29(1):19-27. DOI: 10.1016/j.radi.2022.09.002. View

19.

Martin S, Wichmann J, Weyer H, Scholtz J, Leithner D, Spandorfer A . Endoleaks after endovascular aortic aneurysm repair: Improved detection with noise-optimized virtual monoenergetic dual-energy CT. Eur J Radiol. 2017; 94:125-132. DOI: 10.1016/j.ejrad.2017.06.017. View

20.

Wichmann J, Katzberg R, Litwin S, Zwerner P, De Cecco C, Vogl T . Contrast-Induced Nephropathy. Circulation. 2015; 132(20):1931-6. DOI: 10.1161/CIRCULATIONAHA.115.014672. View