Frederic De Beukelaer, Laura Wuyts, Sophie De Beukelaer, Steven Van Hedent, Omid Nikoubashman, Martin Wiesmann, Michael Veldeman, Rastislav Pjontek, Anke Höllig, Hani Ridwan, Charlotte Weyland
{"title":"光子计数ct血管造影与数字减影血管造影在评估颅内动脉瘤卷曲或夹闭后的效果比较。","authors":"Frederic De Beukelaer, Laura Wuyts, Sophie De Beukelaer, Steven Van Hedent, Omid Nikoubashman, Martin Wiesmann, Michael Veldeman, Rastislav Pjontek, Anke Höllig, Hani Ridwan, Charlotte Weyland","doi":"10.1007/s00234-025-03650-w","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the potential of Photon-Counting Detector CT Angiography (PCD-CTA) for the post-interventional assessment of intracranial aneurysms treated with coil-embolization or clipping, compared to digital subtraction angiography (DSA).</p><p><strong>Methods: </strong>Retrospective analysis of consecutive patients treated with coils or clips between April 2023 and May 2024, who underwent PCD-CTA and, if necessary, DSA as part of their clinical routine. Polyenergetic images and spectral reconstructions were performed at different kiloelectron volt (keV) levels (40, 80 and 120) and with reconstruction kernels: Quantitative (Qr56 and Qr72) and Head vessel (Hv56 and Hv72), both with and without iterative metal artifact reduction (iMAR). Three independent readers assessed image quality using a 5-point Likert scale and region of interest analysis. A blinded, independent reading was performed to determine the presence of aneurysm remnants and intracranial vessel stenosis in the parent vessel.</p><p><strong>Results: </strong>A total of 21 patients (mean age 58 ± 14 years; range 36-74; 18 women) with intracranial, saccular aneurysms treated with either clipping (17/21) or coiling (4/21) were included. Reconstructions using smooth kernels (Hv56, Qr56) at a low keV level (40 keV) yielded increased signal- and contrast-to-noise ratios compared to sharper kernels (Hv72, Qr72) and higher keV levels (80 and 120 keV) (p < 0.001). Unexpectedly, reconstructions with iMAR negatively impacted evaluation, with only 6/21 diagnostic images at the clip site. The sensitivity of PCD-CTA for detecting aneurysm remnants was 100% (7 of 7 aneurysm clip/coil site), while specificity was 89% for patients with clips (8/9). A 100% negative predictive value was observed for all readers regarding aneurysm remnants.</p><p><strong>Conclusion: </strong>Photon-Counting CT-Angiography demonstrated adequate diagnostic value in most patients with intracranial clips. However, while coil artifacts were reduced, spectral reconstructions and iMAR were not sufficient to fully minimize these artifacts.</p>","PeriodicalId":19422,"journal":{"name":"Neuroradiology","volume":" ","pages":"2021-2030"},"PeriodicalIF":2.6000,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Photon-counting CT-angiography in comparison to digital subtraction angiography for assessing intracranial aneurysms after coiling or clipping.\",\"authors\":\"Frederic De Beukelaer, Laura Wuyts, Sophie De Beukelaer, Steven Van Hedent, Omid Nikoubashman, Martin Wiesmann, Michael Veldeman, Rastislav Pjontek, Anke Höllig, Hani Ridwan, Charlotte Weyland\",\"doi\":\"10.1007/s00234-025-03650-w\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>To evaluate the potential of Photon-Counting Detector CT Angiography (PCD-CTA) for the post-interventional assessment of intracranial aneurysms treated with coil-embolization or clipping, compared to digital subtraction angiography (DSA).</p><p><strong>Methods: </strong>Retrospective analysis of consecutive patients treated with coils or clips between April 2023 and May 2024, who underwent PCD-CTA and, if necessary, DSA as part of their clinical routine. Polyenergetic images and spectral reconstructions were performed at different kiloelectron volt (keV) levels (40, 80 and 120) and with reconstruction kernels: Quantitative (Qr56 and Qr72) and Head vessel (Hv56 and Hv72), both with and without iterative metal artifact reduction (iMAR). Three independent readers assessed image quality using a 5-point Likert scale and region of interest analysis. A blinded, independent reading was performed to determine the presence of aneurysm remnants and intracranial vessel stenosis in the parent vessel.</p><p><strong>Results: </strong>A total of 21 patients (mean age 58 ± 14 years; range 36-74; 18 women) with intracranial, saccular aneurysms treated with either clipping (17/21) or coiling (4/21) were included. Reconstructions using smooth kernels (Hv56, Qr56) at a low keV level (40 keV) yielded increased signal- and contrast-to-noise ratios compared to sharper kernels (Hv72, Qr72) and higher keV levels (80 and 120 keV) (p < 0.001). Unexpectedly, reconstructions with iMAR negatively impacted evaluation, with only 6/21 diagnostic images at the clip site. The sensitivity of PCD-CTA for detecting aneurysm remnants was 100% (7 of 7 aneurysm clip/coil site), while specificity was 89% for patients with clips (8/9). A 100% negative predictive value was observed for all readers regarding aneurysm remnants.</p><p><strong>Conclusion: </strong>Photon-Counting CT-Angiography demonstrated adequate diagnostic value in most patients with intracranial clips. However, while coil artifacts were reduced, spectral reconstructions and iMAR were not sufficient to fully minimize these artifacts.</p>\",\"PeriodicalId\":19422,\"journal\":{\"name\":\"Neuroradiology\",\"volume\":\" \",\"pages\":\"2021-2030\"},\"PeriodicalIF\":2.6000,\"publicationDate\":\"2025-08-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Neuroradiology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s00234-025-03650-w\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/6/2 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q2\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Neuroradiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00234-025-03650-w","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/6/2 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
Photon-counting CT-angiography in comparison to digital subtraction angiography for assessing intracranial aneurysms after coiling or clipping.
Purpose: To evaluate the potential of Photon-Counting Detector CT Angiography (PCD-CTA) for the post-interventional assessment of intracranial aneurysms treated with coil-embolization or clipping, compared to digital subtraction angiography (DSA).
Methods: Retrospective analysis of consecutive patients treated with coils or clips between April 2023 and May 2024, who underwent PCD-CTA and, if necessary, DSA as part of their clinical routine. Polyenergetic images and spectral reconstructions were performed at different kiloelectron volt (keV) levels (40, 80 and 120) and with reconstruction kernels: Quantitative (Qr56 and Qr72) and Head vessel (Hv56 and Hv72), both with and without iterative metal artifact reduction (iMAR). Three independent readers assessed image quality using a 5-point Likert scale and region of interest analysis. A blinded, independent reading was performed to determine the presence of aneurysm remnants and intracranial vessel stenosis in the parent vessel.
Results: A total of 21 patients (mean age 58 ± 14 years; range 36-74; 18 women) with intracranial, saccular aneurysms treated with either clipping (17/21) or coiling (4/21) were included. Reconstructions using smooth kernels (Hv56, Qr56) at a low keV level (40 keV) yielded increased signal- and contrast-to-noise ratios compared to sharper kernels (Hv72, Qr72) and higher keV levels (80 and 120 keV) (p < 0.001). Unexpectedly, reconstructions with iMAR negatively impacted evaluation, with only 6/21 diagnostic images at the clip site. The sensitivity of PCD-CTA for detecting aneurysm remnants was 100% (7 of 7 aneurysm clip/coil site), while specificity was 89% for patients with clips (8/9). A 100% negative predictive value was observed for all readers regarding aneurysm remnants.
Conclusion: Photon-Counting CT-Angiography demonstrated adequate diagnostic value in most patients with intracranial clips. However, while coil artifacts were reduced, spectral reconstructions and iMAR were not sufficient to fully minimize these artifacts.
期刊介绍：
Neuroradiology aims to provide state-of-the-art medical and scientific information in the fields of Neuroradiology, Neurosciences, Neurology, Psychiatry, Neurosurgery, and related medical specialities. Neuroradiology as the official Journal of the European Society of Neuroradiology receives submissions from all parts of the world and publishes peer-reviewed original research, comprehensive reviews, educational papers, opinion papers, and short reports on exceptional clinical observations and new technical developments in the field of Neuroimaging and Neurointervention. The journal has subsections for Diagnostic and Interventional Neuroradiology, Advanced Neuroimaging, Paediatric Neuroradiology, Head-Neck-ENT Radiology, Spine Neuroradiology, and for submissions from Japan. Neuroradiology aims to provide new knowledge about and insights into the function and pathology of the human nervous system that may help to better diagnose and treat nervous system diseases. Neuroradiology is a member of the Committee on Publication Ethics (COPE) and follows the COPE core practices. Neuroradiology prefers articles that are free of bias, self-critical regarding limitations, transparent and clear in describing study participants, methods, and statistics, and short in presenting results. Before peer-review all submissions are automatically checked by iThenticate to assess for potential overlap in prior publication.
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