Abstract
Metal artifacts from coils and stents limit the level of detail in C-arm CT images of stent attachment and coiling attenuation in the aneurysm neck. We evaluated the utility of high-resolution C-arm CT combined with streak metal artifact removal technology for stent-assisted embolization of intracranial aneurysms. From October 2017 to July 2018, the First Affiliated Hospital of Zhengzhou University treated 107 patients with intracranial aneurysms (118 aneurysms in total) with stent-assisted embolization. Conventional C-arm CT and high-resolution C-arm CT scanning of the stented area were performed during and after treatment. 3D images were reconstructed with and without streak metal artifact removal techniques. Subsequently, the image quality was compared. The reconstructed images indicated the stent deployment degree and packing density. Follow-up assessments included clinical and angiographic outcomes and complications. In total, 118 aneurysms were successfully embolized using 118 stents. Image quality was significantly higher (P < .05) with high-resolution C-arm CT combined with streak metal artifact removal reconstruction. Streak metal artifact removal reconstruction and 2D angiography at working angles showed incomplete deployment of 6 stents and incomplete aneurysm embolization of 15 patients, which were subsequently resolved. One case of hemorrhage was noted postoperatively. Follow-up of 93 patients at 6-13 months indicated 3 cases of aneurysm recurrence. High-resolution C-arm CT combined with the streak metal artifact removal technique effectively reduced metal artifacts from stents and coils during aneurysm embolization. This method can help physicians determine the extent of stent deployment and the packing density of coils and thus potentially reduce complications and aneurysm recurrence.
Highlights
BACKGROUND AND PURPOSEMetal artifacts from coils and stents limit the level of detail in C-arm CT images of stent attachment and coiling attenuation in the aneurysm neck
High-resolution C-arm CT combined with the streak metal artifact removal technique effectively reduced metal artifacts from stents and coils during aneurysm embolization
In an in vitro aneurysm model, we observed that this new technique significantly improved the postprocessing quality of images of stents and coils, such as stent skeleton development and wire and coil metal artifact reduction (Fig 1)
Summary
From October 2017 to July 2018, the First Affiliated Hospital of Zhengzhou University treated 107 patients with intracranial aneurysms (118 aneurysms in total) with stent-assisted embolization. MAR techniques are widely used in spiral CT and MR imaging to reduce artifacts generated by metal implants and improve the overall image quality. Their application in C-arm CT is still in its infancy, and only a few reports are found in the literature. Van der Bom et al[12] reported 25 cases of stent-assisted coil embolization using high-resolution VasoCT combined with MAR. They found that the technology significantly improved the image quality, it still could.
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