title: Separating the wheat from the chaff: region of interest combined with metal artifact reduction for completion angiography following cerebral aneurysm treatment.
abstract: BACKGROUND
  Following complicated endovascular or microsurgical treatments, assessment of radiographic outcome can be challenging due to device resolution and metallic artifact. Two-dimensional and three-dimensional angiography can reveal information about flow and aneurysm obliteration, but may be limited by beam hardening, overlapping vessels, and image degradation in the region of metallic implants. In this study, we investigated the combination of a collimated volumetric imaging (volume of interest, VOI) protocol followed by metal artifact reduction (MAR) post-processing to evaluate the correct positioning of stents, flow diverters, coils, and clips while limiting the radiation dose to the patient.
  
  
  METHODS
  9 patients undergoing 10 procedures were included in our study. All patients underwent endovascular or surgical treatment of a cerebral aneurysm involving stents, flow diverting stents, coils, and/or clips followed by either immediate or early postoperative evaluation of our protocol.
  
  
  RESULTS
  Image datasets corrected for metallic artifacts (VOI-MAR) were judged to be better-a statistically significant finding-than image datasets only corrected for field of view truncation (VOI alone). Qualitatively, images were more interpretable and informative with regards to device position and apposition to the vessel wall for those cases involving a pipeline, and with regards to encroachment on the parent artery and possible residual aneurysm, in all cases.
  
  
  CONCLUSIONS
  VOI acquisition combined with MAR post-processing provides for accurate and informative evaluation of cerebral aneurysm treatment while limiting the radiation dose to patients.
authors.affiliation: Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA.
authors.forename: Edward A M
authors.initials: EA
authors.lastname: Duckworth
authors.affiliation: Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA.
authors.forename: Chris
authors.initials: C
authors.lastname: Nickele
authors.affiliation: Siemens Medical Solutions USA, Hoffman Estates, Illinois, USA.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Schafer
authors.affiliation: Siemens Medical Solutions USA, Hoffman Estates, Illinois, USA.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Bauer
authors.affiliation: Siemens Medical Solutions USA, Hoffman Estates, Illinois, USA.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Scholz
authors.affiliation: Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA Department of Neurology, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA.
authors.forename: Lucas
authors.initials: L
authors.lastname: Elijovich
authors.affiliation: Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Hoit
authors.affiliation: Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA Department of Neurology, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA.
authors.forename: Vinodh T
authors.initials: VT
authors.lastname: Doss
authors.affiliation: Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA.
authors.forename: Adam S
authors.initials: AS
authors.lastname: Arthur
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016477:Artifacts; D002533:Cerebral Angiography / Q000379:methods* / Q000592:standards; D004621:Embolization, Therapeutic / Q000379:methods* / Q000592:standards; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000628:therapy*; D008297:Male; D008670:Metals; D008875:Middle Aged; D015607:Stents / Q000592:standards; D013525:Surgical Instruments / Q000592:standards; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
chemical_list: D008670:Metals
keywords: Aneurysm; Angiography; Coil