Comparison of CT and MRI artefacts from coils and vascular plugs used for portal vein embolization

Plug-Based Embolization Techniques of Aortic Side Branches during Standard and Complex Endovascular Aortic Repair

Vascular plugs are an evolving family of vessel occluders providing a single-device embolization system for large, high-flow arteries. Nitinol mesh plugs and polytetrafluoroethylene membrane plugs are available in different configurations and sizes to occlude arteries from 3 to 20 mm in diameter. Possible applications during complex endovascular aortic procedures are aortic branch embolization to prevent endoleak or to gain an adequate landing zone, directional branch occlusion, and false lumen embolization in aortic dissection. Plugs are delivered through catheters or introducers, and their technical and clinical results are comparable to those of coil embolization. Plugs are more accurate than coils as repositionable devices, less prone to migration, and have fewer blooming artifacts on postoperative computed tomography imaging. Their main drawback is the need for larger delivery systems. This narrative review describes up-to-date techniques and technology for plug embolization in complex aortic repair.

Reduction of Metallic Artifacts of the Post-treatment Intracranial Aneurysms: Effects of Single Energy Metal Artifact Reduction Algorithm

PURPOSE

This study evaluated the quality of computed tomography (CT) and CT angiography images generated using the single-energy metal artifact reduction (SEMAR) algorithm during perfusion examination in patients who had undergone reconstruction with neurosurgical clipping or endovascular coiling for treatment of aneurysms.

METHODS

A total of 55 patients with implanted intracranial clips or coils (24 men and 31 women; mean age 60.15 ± 15.86 years) underwent perfusion studies evaluated by CT and CT angiography with a 320-row CT scanner. Images were reconstructed with either the SEMAR algorithm combined with iterative reconstruction (SEMAR group), or by iterative reconstruction only (non-SEMAR group control). The SEMAR and control images were compared for artifacts (index and maximum diameter), image quality, cerebral perfusion parameters, noise (images with the worst artifacts), and contrast-to-noise ratio. The metallic artifacts were visually evaluated by two radiologists using a four-point scale in a double-blinded manner.

RESULTS

The noise, artifact diameter, and artifact index of the SEMAR images were significantly lower than that of the control images, and the subjective image quality score and contrast-to-noise ratio were significantly higher (P < 0.01, all). The cerebral perfusion parameters of the SEMAR and control images were comparable (i. e. blood flow, blood volume, and mean transit time).

CONCLUSION

For imaging intracranial metallic implants, the SEMAR algorithm produced images with significantly fewer artifacts than the iterative reconstruction alone, with no statistical changes in perfusion parameters. Thus, SEMAR reconstruction can be instrumental in improving CT image quality and may ultimately improve the detection of postoperative complications and patient prognosis.

Role of imaging for patients with colorectal hepatic metastases: what the radiologist needs to know

Surgical resection of colorectal metastatic disease has increased as surgeons have adopted a more aggressive ideology. Current exclusion criteria are patients for whom a negative resection margin is not feasible or a future liver remnant (FLR) of greater than 20% is not achievable. The goal of preoperative imaging is to identify the number and distribution of liver metastases, in addition to establishing their relation to relevant intrahepatic structures. FLR can be calculated utilizing cross-sectional imaging to select out patients at risk for hepatic dysfunction after resection. MRI, specifically with gadoxetic acid contrast, is currently the preferred modality for assessment of hepatic involvement for patients with newly diagnosed colorectal cancer, to include those who have undergone neoadjuvant chemotherapy. Employment of liver-directed therapies has recently expanded and they may provide an alternative to hepatectomy in order to obtain locoregional control in poor surgical candidates or convert patients with initially unresectable disease into surgical candidates.

Reduction of metallic coil artefacts in computed tomography body imaging: effects of a new single-energy metal artefact reduction algorithm

OBJECTIVES

We evaluated the effect of a single-energy metal artefact reduction (SEMAR) algorithm for metallic coil artefact reduction in body imaging.

METHODS

Computed tomography angiography (CTA) was performed in 30 patients with metallic coils (10 men, 20 women; mean age, 67.9 ± 11 years). Non-SEMAR images were reconstructed with iterative reconstruction alone, and SEMAR images were reconstructed with the iterative reconstruction plus SEMAR algorithms. We compared image noise around metallic coils and the maximum diameters of artefacts from coils between the non-SEMAR and SEMAR images. Two radiologists visually evaluated the metallic coil artefacts utilizing a four-point scale: 1 = extensive; 2 = strong; 3 = mild; 4 = minimal artefacts.

RESULTS

The image noise and maximum diameters of the artefacts of the SEMAR images were significantly lower than those of the non-SEMAR images (65.1 ± 33.0 HU vs. 29.7 ± 10.3 HU; 163.9 ± 54.8 mm vs. 10.3 ± 19.0 mm, respectively; P < 0.001). Better visual scores were obtained with the SEMAR technique (3.4 ± 0.6 vs. 1.0 ± 0.0, P < 0.001).

CONCLUSIONS

The SEMAR algorithm significantly reduced artefacts caused by metallic coils compared with the non-SEMAR algorithm. This technique can potentially increase CT performance for the evaluation of post-coil embolization complications.

KEY POINTS

• The new algorithm involves a raw data- and image-based reconstruction technique. • The new algorithm mitigates artefacts from metallic coils on body CT images. • The new algorithm significantly reduced artefacts caused by metallic coils. • The metal artefact reduction algorithm improves CT image quality after coil embolization.