ArticleAbdominal radiology (New York)2026
Dual-energy CT with metal artifact reduction for post-EVAR CTA surveillance: a prospective study with image quality analysis.
Article in Abdominal radiology (New York), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeTo evaluate the value of dual-energy computed tomography (DECT) combined with the iterative metal artifact reduction (iMAR) for postoperative endovascular aortic repair (EVAR) CT angiography (CTA) surveillance.
methodsIn this prospective study, post-EVAR CTA surveillance was performed using a Siemens Force CT (100/150 kVp dual-energy). Images were reconstructed as conventional mixed and 40-190 keV virtual monoenergetic images (VMIs), with and without iMAR. Image quality was assessed via quantitative parameters and 5-point subjective scores, with clinical data and radiation dose recorded simultaneously. Diagnostic performance was referenced to surgical/DSA findings and blinded expert adjudication. Statistical analysis was performed via two-way repeated-measures ANOVA with post-hoc paired t-tests or Wilcoxon tests for quantitative parameters, While subjective scores were analyzed using the Friedman test with post-hoc Wilcoxon signed-rank tests. P values were Bonferroni-corrected; corrected P < 0.05 indicated significance.
resultsFifty post-EVAR patients (82% male; 68.7 ± 8.9 years) received safe radiation doses; stent type yielded no quantitative differences (P > 0.05). iMAR-DECT synergistically enhanced image quality, with improvements correlating positively with artifact severity while sparing normal tissues for iMAR. Energy levels dominated the trend: most parameters declined rapidly at 40-70 keV but plateaued beyond 100 keV. iMAR significantly outperformed non-iMAR in scores of artifact reduction (plateauing at 150-190 keV) and vessel visibility (peaking at 90 keV, P < 0.01). For diagnosis, iMAR+DECT converted five false negatives into true positives (endoleaks, thrombosis, infection), showing a trend toward higher sensitivity than those for non-iMAR+DECT (P > 0.05, large effect size).
conclusionThe integration of DECT-VMIs with the iMAR algorithm appears to improve image quality in post-EVAR CTA by effectively reducing stent-related metal artifacts while enhancing vascular and soft-tissue visualization. Based on our quantitative and qualitative assessments, an energy level of 90 keV (effective range 80-100 keV) may be considered optimal to optimize diagnostic evaluation, pending validation in larger, multi-center cohorts.
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