• Vincent Dunet, Martine Bernasconi, Steven David Hajdu, Reto Antoine Meuli, Roy Thomas Daniel, and Jean-Baptiste Zerlauth.
• Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Rue du Bugnon 46, 1003, Lausanne, Switzerland. Vincent.Dunet@chuv.ch.
• Neuroradiology. 2017 Sep 1; 59 (9): 845-852.

PurposeWe aimed to assess the impact of metal artifact reduction software (MARs) on image quality of gemstone spectral imaging (GSI) dual-energy (DE) cerebral CT angiography (CTA) after intracranial aneurysm clipping.MethodsThis retrospective study was approved by the institutional review board, which waived patient written consent. From January 2013 to September 2016, single source DE cerebral CTA were performed in 45 patients (mean age: 60 ± 9 years, male 9) after intracranial aneurysm clipping and reconstructed with and without MARs. Signal-to-noise (SNR), contrast-to-noise (CNR), and relative CNR (rCNR) ratios were calculated from attenuation values measured in the internal carotid artery (ICA) and middle cerebral artery (MCA). Volume of clip and artifacts and relative clip blurring reduction (rCBR) ratios were also measured at each energy level with/without MARs. Variables were compared between GSI and GSI-MARs using the paired Wilcoxon signed-rank test.ResultsMARs significantly reduced metal artifacts at all energy levels but 130 and 140 keV, regardless of clips' location and number. The optimal rCBR was obtained at 110 and 80 keV, respectively, on GSI and GSI-MARs images, with up to 96% rCNR increase on GSI-MARs images. The best compromise between metal artifact reduction and rCNR was obtained at 70-75 and 65-70 keV for GSI and GSI-MARs images, respectively, with up to 15% rCBR and rCNR increase on GSI-MARs images.ConclusionMARs significantly reduces metal artifacts on DE cerebral CTA after intracranial aneurysm clipping regardless of clips' location and number. It may be used to reduce radiation dose while increasing CNR.

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