, Volume 60, Issue 12, pp 1287–1295 | Cite as

Value of dual-energy CT angiography in patients with treated intracranial aneurysms

  • Iulia Mocanu
  • Morgane Van Wettere
  • Julie Absil
  • Michaël Bruneau
  • Boris Lubicz
  • Niloufar SadeghiEmail author
Diagnostic Neuroradiology



To evaluate the ability of dual-energy CT angiography (DECTA) in metal artifact reduction in patients with treated intracranial aneurysms by comparing DECTA-based virtual monoenergetic extrapolations (VMEs) and mixed images (MI).


Thirty-five patients underwent prospectively a dual-source DECTA (Somatom Force, Siemens Medical Solutions, Forchheim, Germany) after aneurysm repair. A total number of 40 aneurysms (23 treated by coil embolization and 17 treated by surgical clipping) were analyzed. Mixed images (equivalent to a conventional single-energy CT angiography) were compared to VMEs at 75, 95, and 115 keV. Artifact severity was assessed quantitatively by measuring the mean attenuation value and standard deviation within regions of interest placed in the most hypodense coil or clip artifact area. Artifact severity score and contrast vessel score were also assessed qualitatively by two independent blinded readers.


In those aneurysms treated by surgical clipping, quantitative and qualitative analyses showed significant reduction of artifacts on VMEs compared to MI with the best compromise being obtained at 95 keV in order to keep an optimal vessel contrast in the adjacent vessel. In those aneurysms treated by coil embolization, there was no significant reduction of artifacts both on quantitative and qualitative analyses.


Dual-source DECTA was helpful in order to reduce clip artifacts on VMEs with the optimal adjacent vessel visualization obtained at 95 keV, whereas this technique was not helpful in aneurysms treated by coiling.


Dual-energy CT Aneurysm Coil embolization Surgical clipping Metallic artifacts 


Compliance with ethical standards


No funding was received for this study.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Li H, Pan R, Wang H, Rong X, Yin Z, Milgrom DP, Shi X, Tang Y, Peng Y (2013) Clipping versus coiling of ruptured intracranial aneuryms, a systematic review and meta-analysis. Stroke 44:29–37CrossRefGoogle Scholar
  2. 2.
    Johnston SC, Dowd CF, Higashida RT, Lawton MT, Duckwiler GR, Gress DR (2008) Predictors of rehemorrhage after treatment of ruptured intracranial aneurysms, the CARAT study. Stroke 39:120–125CrossRefGoogle Scholar
  3. 3.
    Kaufmann TJ, Huston IIIJ, Mandrekar JN, Schleck CD, Thielen KR, Kallmes DF (2007) Complications of diagnostic cerebral angiography: evaluation of 19 826 consecutive patients. Radiology 243:812–819CrossRefGoogle Scholar
  4. 4.
    Dehdashti AR, Binaghi S, Uske A, Regli L (2006) Comparison of multislice computerized tomography angiography and digital subtraction angiography in the postoperative evaluation of patients with clipped aneurysms. J Neurosurg 104:395–403CrossRefGoogle Scholar
  5. 5.
    Wallace RC, Karis JP, Partovi S, Fiorella D (2007) Noninvasive imaging of treated cerebral aneurysms, part I: MR angiographic follow-up of coiled aneurysms. AJNR Am J Neuroradiol 28:1001–1008CrossRefGoogle Scholar
  6. 6.
    Wallace RC, Karis JP, Partovi S, Fiorella D (2007) Noninvasive imaging of treated cerebral aneurysms, part II: CT angiographic follow-up of surgically clipped aneurysms. AJNR Am J Neuroradiol 28:1207–1212CrossRefGoogle Scholar
  7. 7.
    Gölitz P, Struffert T, Ganslandt O, Saake M, Lücking H, Rösch J, Knossalla F, Doerfler A (2012) Optimized angiographic computed tomography with intravenous contrast injection: an alternative to conventional angiography in the follow-up of clipped aneurysms? J Neurosurg 117:29–36CrossRefGoogle Scholar
  8. 8.
    Schaafsma JD, Koffijberg H, Buskens E, Velthuis BK, van der Graaf Y, Rinkel GJE (2010) Cost-effectiveness of magnetic resonance angiography versus intra-arterial digital subtraction angiography to follow-up patients with coiled intra-cranial aneurysms. Stroke 41:1736–1742CrossRefGoogle Scholar
  9. 9.
    Marin D, Boll DT, Mileto A, Nelson RC (2014) State of the art: dual-energy CT of the abdomen. Radiology 271:327–342CrossRefGoogle Scholar
  10. 10.
    Patino M, Prochwoski A, Agrawal MD, Simeone FJ, Gupta R, Hahn PF, Sahani DV (2016) Material separation using dual-energy CT: current and emerging applications. Radiographics 36:1087–1105CrossRefGoogle Scholar
  11. 11.
    Johnson TRC (2012) Dual-energy CT: general principles. AJR 199:S3–S8CrossRefGoogle Scholar
  12. 12.
    McCollough CH, Leng S, Yu L, Fletcher JG (2015) Dual- and multi-energy CT: principles, technical approaches, and clinical applications. Radiology 276:637–653CrossRefGoogle Scholar
  13. 13.
    Bamberg F, Dierks A, Nikolaou K, Reiser MF, Becker CR, Johnson TRC (2011) Metal artifact reduction by dual energy computed tomography using monoenergetic extrapolation. Eur Radiol 21:1424–1429CrossRefGoogle Scholar
  14. 14.
    Fahrendorf DM, Goericke SM, Oezkan M, Breyer T, Hussain S, Sandalcioglu EI, Sure U, Forsting M, Gizewski ER (2011) The value of dual-energy CTA for control of surgically clipped aneurysms. Eur Radiol 21:2193–2201CrossRefGoogle Scholar
  15. 15.
    Shinohara Y, Sakamoto M, Iwata N, Kishimoto J, Kuya K, Fujii S, Kaminou T, Watanabe T, Ogawa T (2014) Usefulness of monochromatic imaging with metal artifact reduction software for computed tomography angiography after intracranial aneurysm coil embolization. Acta Radiol 55:1015–1023CrossRefGoogle Scholar
  16. 16.
    Dolati P, Eichberg D, Wong JH, Goyal M (2015) The utility of dual-energy computed tomographic angiography for the evaluation of brain aneurysms after surgical clipping: a prospective study. World Neurosurg 84:1362–1371CrossRefGoogle Scholar
  17. 17.
    Dunet V, Bernasconi M, Hajdu SD, Meuli RA, Daniel RT, Zerlauth JB (2017) Impact of metal artifact reduction software on image quality of gemstone spectral imaging dual-energy cerebral CT angiography after intracranial aneurysm clipping. Neuroradiology 59:845–852CrossRefGoogle Scholar
  18. 18.
    Jia Y, Zhang J, Fan J, Sun Y, Li D, Xiao X (2015) Gemstone spectral imaging reduced artefacts from metal coils or clips after treatment of cerebral aneurysms: a retrospective study of 35 patients. Br J Radiol 88:20150222CrossRefGoogle Scholar
  19. 19.
    Yu L, Primak AN, Liu X, McCollough CH (2009) Image quality optimization and evaluation of linearly mixed images in dual-source, dual-energy-CT. Med Phys 36:1019–1024CrossRefGoogle Scholar
  20. 20.
    Yu L, Leng S, McCollough CH (2012) Dual-energy CT based monochromatic imaging. AJR Am J Roentgenol 199:S9–S15CrossRefGoogle Scholar
  21. 21.
    Yu L, Christner JA, Leng S, Wang J, Fletcher JG, McCollough CH (2011) Virtual monochromatic imaging in dual-source dual-energy CT: radiation dose and image quality. Med Phys 38:6371–6379CrossRefGoogle Scholar
  22. 22.
    Landis J, Koch G (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174CrossRefGoogle Scholar
  23. 23.
    Winklhofer S, Hinzpeter R, Stocker D, Baltsavias G, Michels L, Burkhardt JK, Regli L, Valavanis A, Alkadhi H (2018) Combining monoenergetic extrapolations from dual-energy CT with iterative reconstructions: reduction of coil and clip artifacts from intracranial aneurysm therapy. Neuroradiology 60:281–291CrossRefGoogle Scholar
  24. 24.
    Postma AA, Das M, Stadler AA, Wildberger JE (2015) Dual-energy CT: what the neuroradiologist should know. Curr Radiol Rep 3:16CrossRefGoogle Scholar
  25. 25.
    Postma AA, Hofman PAM, Stadler AAR, van Oostenbrugge RJ, Tijssen MPM, Wildberger JE (2012) Dual-energy CT of the brain and intracranial vessels. AJR Am J Roentgenol 199:S26–S33CrossRefGoogle Scholar
  26. 26.
    Henzler T, Fink C, Schoenberg SO, Schoepf UJ (2012) Dual-energy CT: radiation dose aspects. AJR Am J Roentgenol 199:S16–S25CrossRefGoogle Scholar
  27. 27.
    Bakker NA, Westerlaan HE, Metzemaekers JDM, van Dijk MC, Eshghi OS, Mooij JJA, Groen RJM (2010) Feasibility of magnetic resonance angiography (MRA) follow-up as the primary imaging modality after coiling of intracranial aneurysms. Acta Radiol 51:226–232CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Iulia Mocanu
    • 1
  • Morgane Van Wettere
    • 1
  • Julie Absil
    • 1
  • Michaël Bruneau
    • 2
  • Boris Lubicz
    • 3
  • Niloufar Sadeghi
    • 1
    Email author
  1. 1.Department of RadiologyErasme Hospital-ULBBrusselsBelgium
  2. 2.Department of NeurosurgeryErasme Hospital-ULBBrusselsBelgium
  3. 3.Department of Interventional NeuroradiologyErasme Hospital-ULBBrusselsBelgium

Personalised recommendations