Virtual monoenergetic images and post-processing algorithms effectively reduce CT artifacts from intracranial aneurysm treatment

To evaluate artifact reduction by virtual monoenergetic images (VMI) and metal artifact reduction algorithms (MAR) as well as the combination of both approaches (VMI(MAR)) compared to conventional CT images (CI) as standard of reference. In this retrospective study, 35 patients were included who underwent spectral-detector CT (SDCT) with additional MAR-reconstructions due to artifacts from coils or clips. CI, VMI, MAR and VMI(MAR) (range: 100–200 keV, 10 keV-increment) were reconstructed. Region-of-interest based objective analysis was performed by assessing mean and standard deviation of attenuation (HU) in hypo- and hyperdense artifacts from coils and clips. Visually, extent of artifact reduction and diagnostic assessment were rated. Compared to CI, VMI ≥ 100 keV, MAR and VMI(MAR) between 100–200 keV increased attenuation in hypoattenuating artifacts (CI/VMI(200keV)/MAR/VMI(MAR200keV), HU: −77.6 ± 81.1/−65.1 ± 103.2/−36.9 ± 27.7/−21.1 ± 26.7) and decreased attenuation in hyperattenuating artifacts (HU: 47.4 ± 32.3/42.1 ± 50.2/29.5 ± 18.9/20.8 ± 25.8). However, differences were only significant for MAR in hypodense and VMI(MAR) in hypo- and hyperdense artifacts (p < 0.05). Visually, hypo- and hyperdense artifacts were significantly reduced compared to CI by VMI(≥140/100keV), MAR and VMI(MAR≥100keV). Diagnostic assessment of surrounding brain tissue was significantly improved in VMI(≥100keV), MAR and VMI(MAR≥100keV). The combination of VMI and MAR facilitates a significant reduction of artifacts adjacent to intracranial coils and clips. Hence, if available, these techniques should be combined for optimal reduction of artifacts following intracranial aneurysm treatment.