Reduction of Coil Mass Artifacts in High-Resolution Flat Detector Conebeam CT of Cerebral Stent-Assisted Coiling

BACKGROUND AND PURPOSE: Developments in flat panel angiographic C-arm systems have enabled visualization of both the neurovascular stents and host arteries in great detail, providing complementary spatial information in addition to conventional DSA. However, the visibility of these structures may be impeded by artifacts generated by adjacent radio-attenuating objects. We report on the use of a metal artifact reduction algorithm for high-resolution contrast-enhanced conebeam CT for follow-up imaging of stent-assisted coil embolization. MATERIALS AND METHODS: Contrast-enhanced conebeam CT data were acquired in 25 patients who underwent stent-assisted coiling. Reconstructions were generated with and without metal artifact reduction and were reviewed by 3 experienced neuroradiologists by use of a 3-point scale. RESULTS: With metal artifact reduction, the observers agreed that the visibility had improved by at least 1 point on the scoring scale in >40% of the cases (κ = 0.6) and that the streak artifact was not obscuring surrounding structures in 64% of all cases (κ = 0.6). Metal artifact reduction improved the image quality, which allowed for visibility sufficient for evaluation in 65% of the cases, and was preferred over no metal artifact reduction in 92% (κ = 0.9). Significantly higher scores were given with metal artifact reduction (P < .0001). CONCLUSIONS: Although metal artifact reduction is not capable of fully removing artifacts caused by implants with high x-ray absorption, we have shown that the image quality of contrast-enhanced conebeam CT data are improved drastically. The impact of the artifacts on the visibility varied between cases, and yet the overall visibility of the contrast-enhanced conebeam CT with metal artifact reduction improved in most the cases.

[1]  A. Wakhloo,et al.  Closed-Cell Stent for Coil Embolization of Intracranial Aneurysms: Clinical and Angiographic Results , 2012, American Journal of Neuroradiology.

[2]  Rainer Raupach,et al.  Normalized Metal Artifact Reduction in Head and Neck Computed Tomography , 2012, Investigative radiology.

[3]  Daniel Ruijters,et al.  Validation of 3D multimodality roadmapping in interventional neuroradiology , 2011, Physics in medicine and biology.

[4]  Habib Zaidi,et al.  Reduction of artefacts caused by hip implants in CT-based attenuation-corrected PET images using 2-D interpolation of a virtual sinogram on an irregular grid , 2011, European Journal of Nuclear Medicine and Molecular Imaging.

[5]  P. D. De with,et al.  High-resolution 3D X-ray imaging of intracranial nitinol stents , 2011, Neuroradiology.

[6]  Konstantin Nikolaou,et al.  Metal artifact reduction by dual energy computed tomography using monoenergetic extrapolation , 2011, European Radiology.

[7]  N. Noordhoek,et al.  Contrast-Enhanced Angiographic Cone-Beam CT of Cerebrovascular Stents: Experimental Optimization and Clinical Application , 2010, American Journal of Neuroradiology.

[8]  W A Kalender,et al.  Development, implementation and evaluation of a dedicated metal artefact reduction method for interventional flat-detector CT. , 2010, The British journal of radiology.

[9]  W A Kalender,et al.  Metal Artifact Reduction for Clipping and Coiling in Interventional C-Arm CT , 2010, American Journal of Neuroradiology.

[10]  Jacob Geleijns,et al.  Development and validation of segmentation and interpolation techniques in sinograms for metal artifact suppression in CT. , 2010, Medical physics.

[11]  Raphaël Blanc,et al.  Stent-Assisted Coiling of Intracranial Aneurysms: Clinical and Angiographic Results in 216 Consecutive Aneurysms , 2010, Stroke.

[12]  Habib Zaidi,et al.  Reduction of dental filling metallic artifacts in CT-based attenuation correction of PET data using weighted virtual sinograms , 2009, 2009 IEEE Nuclear Science Symposium Conference Record (NSS/MIC).

[13]  David Faul,et al.  Suppression of Metal Artifacts in CT Using a Reconstruction Procedure That Combines MAP and Projection Completion , 2009, IEEE Transactions on Medical Imaging.

[14]  A. Wakhloo,et al.  Stent-Assisted Reconstructive Endovascular Repair of Cranial Fusiform Atherosclerotic and Dissecting Aneurysms: Long-Term Clinical and Angiographic Follow-Up , 2008, Stroke.

[15]  D. Babic,et al.  Brain imaging with a flat detector C-arm , 2008, Neuroradiology.

[16]  Andreas Hierlemann,et al.  Proceedings of the Sixth IASTED International Conference on Biomedical Engineering , 2008 .

[17]  Paul Suetens,et al.  GPU-accelerated digitally reconstructed radiographs , 2008 .

[18]  B. Bendok,et al.  Giant Intracranial Aneurysms: Endovascular Challenges , 2006, Neurosurgery.

[19]  B. Bendok,et al.  THE EFFECT OF VASCULAR RECONSTRUCTION DEVICE‐ASSISTED COILING ON PACKING DENSITY, EFFECTIVE NECK COVERAGE, AND ANGIOGRAPHIC OUTCOME: AN IN VITRO STUDY , 2007, Neurosurgery.

[20]  Haim Azhari,et al.  The reduction of artifacts due to metal hip implants in CT-attenuation corrected PET images from hybrid PET/CT scanners , 2007, Medical & Biological Engineering & Computing.

[21]  Frank P DiFilippo,et al.  A knowledge-based method for reducing attenuation artefacts caused by cardiac appliances in myocardial PET/CT , 2006, Physics in medicine and biology.

[22]  D. Fiorella,et al.  Usefulness of the Neuroform Stent for the Treatment of Cerebral Aneurysms: Results at Initial (3–6-mo) Follow-up , 2005, Neurosurgery.

[23]  R. Rosenwasser,et al.  ENDOVASCULAR OCCLUSION OF WIDE-NECKED ANEURYSMS WITH A NEW INTRACRANIAL MICROSTENT (NEUROFORM) AND DETACHABLE COILS , 2004, Neurosurgery.

[24]  Patrick Dupont,et al.  An iterative maximum-likelihood polychromatic algorithm for CT , 2001, IEEE Transactions on Medical Imaging.

[25]  W. Kalender,et al.  Generalized multi-dimensional adaptive filtering for conventional and spiral single-slice, multi-slice, and cone-beam CT. , 2001, Medical physics.

[26]  S. Zhao,et al.  X-ray CT metal artifact reduction using wavelets: an application for imaging total hip prostheses , 2000, IEEE Transactions on Medical Imaging.

[27]  A. Wakhloo,et al.  Efficacy and current limitations of intravascular stents for intracranial internal carotid, vertebral, and basilar artery aneurysms. , 1999, Journal of neurosurgery.

[28]  R. Higashida,et al.  Intravascular stent and endovascular coil placement for a ruptured fusiform aneurysm of the basilar artery. Case report and review of the literature. , 1997, Journal of neurosurgery.

[29]  D. Robertson,et al.  Total hip prosthesis metal-artifact suppression using iterative deblurring reconstruction. , 1997, Journal of computer assisted tomography.

[30]  Joseph A. O'Sullivan,et al.  Iterative deblurring for CT metal artifact reduction , 1996, IEEE Trans. Medical Imaging.

[31]  G. Duckwiler,et al.  Endovascular treatment of fusiform aneurysms with stents and coils: technical feasibility in a swine model. , 1995, AJNR. American journal of neuroradiology.

[32]  J Haberstroh,et al.  Self-expanding and balloon-expandable stents in the treatment of carotid aneurysms: an experimental study in a canine model. , 1994, AJNR. American journal of neuroradiology.

[33]  W. Kalender,et al.  Reduction of CT artifacts caused by metallic implants. , 1987 .

[34]  L. Feldkamp,et al.  Practical cone-beam algorithm , 1984 .

[35]  G. Glover,et al.  An algorithm for the reduction of metal clip artifacts in CT reconstructions. , 1981, Medical physics.

[36]  Jacob Cohen,et al.  The Equivalence of Weighted Kappa and the Intraclass Correlation Coefficient as Measures of Reliability , 1973 .