title: High-Resolution C-Arm CT and Metal Artifact Reduction Software: A Novel Imaging Modality for Analyzing Aneurysms Treated with Stent-Assisted Coil Embolization.
abstract: OBJECTIVE
  Combination of high-resolution C-arm CT and novel metal artifact reduction software may contribute to the assessment of aneurysms treated with stent-assisted coil embolization. This study aimed to evaluate the efficacy of a novel Metal Artifact Reduction prototype software combined with the currently available high spatial-resolution C-arm CT prototype implementation by using an experimental aneurysm model treated with stent-assisted coil embolization.
  
  
  METHODS
  Eight experimental aneurysms were created in 6 swine. Coil embolization of each aneurysm was performed by using a stent-assisted technique. High-resolution C-arm CT with intra-arterial contrast injection was performed immediately after the treatment. The obtained images were processed with Metal Artifact Reduction. Five neurointerventional specialists reviewed the image quality before and after Metal Artifact Reduction. Observational and quantitative analyses (via image analysis software) were performed.
  
  
  RESULTS
  Every aneurysm was successfully created and treated with stent-assisted coil embolization. Before Metal Artifact Reduction, coil loops protruding through the stent lumen were not visualized due to the prominent metal artifacts produced by the coils. These became visible after Metal Artifact Reduction processing. Contrast filling in the residual aneurysm was also visualized after Metal Artifact Reduction in every aneurysm. Both the observational (P < .0001) and quantitative (P < .001) analyses showed significant reduction of the metal artifacts after application of the Metal Artifact Reduction prototype software.
  
  
  CONCLUSIONS
  The combination of high-resolution C-arm CT and Metal Artifact Reduction enables differentiation of the coil mass, stent, and contrast material on the same image by significantly reducing the metal artifacts produced by the platinum coils. This novel image technique may improve the assessment of aneurysms treated with stent-assisted coil embolization.
authors.affiliation: From the Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan. ichiroyuki@gmail.com.
authors.forename: I
authors.identifier: http://orcid.org/0000-0002-7673-9085
authors.initials: I
authors.lastname: Yuki
authors.affiliation: From the Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Kambayashi
authors.affiliation: From the Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan.
authors.forename: A
authors.initials: A
authors.lastname: Ikemura
authors.affiliation: From the Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Abe
authors.affiliation: From the Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan.
authors.forename: I
authors.identifier: http://orcid.org/0000-0003-4829-4784
authors.initials: I
authors.lastname: Kan
authors.affiliation: From the Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan.
authors.forename: A
authors.initials: A
authors.lastname: Mohamed
authors.affiliation: From the Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan.
authors.forename: C
authors.identifier: http://orcid.org/0000-0002-7505-1211
authors.initials: C
authors.lastname: Dahmani
authors.affiliation: From the Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan.
authors.forename: T
authors.identifier: http://orcid.org/0000-0001-7172-0257
authors.initials: T
authors.lastname: Suzuki
authors.affiliation: From the Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan.
authors.forename: T
authors.identifier: http://orcid.org/0000-0003-1044-5604
authors.initials: T
authors.lastname: Ishibashi
authors.affiliation: From the Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan.
authors.forename: H
authors.identifier: http://orcid.org/0000-0002-9285-9642
authors.initials: H
authors.lastname: Takao
authors.affiliation: From the Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Urashima
authors.affiliation: From the Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Y
authors.identifier: http://orcid.org/0000-0003-3490-385X
authors.initials: Y
authors.lastname: Murayama
mesh_terms: D000818:Animals; D016477:Artifacts; D004195:Disease Models, Animal; D004621:Embolization, Therapeutic / Q000295:instrumentation / Q000379:methods; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000628:therapy; D012984:Software; D015607:Stents; D013552:Swine; D014057:Tomography, X-Ray Computed / Q000379:methods*