Dual-energy direct bone removal CT angiography for evaluation of intracranial aneurysm or stenosis: comparison with conventional digital subtraction angiography

Dual-energy CT can be applied for bone elimination in cerebral CT angiography (CTA). The aim of this study was to compare the results of dual-energy direct bone removal CTA (DE-BR-CTA) with those of digital subtraction angiography (DSA). Twelve patients with intracranial aneurysms and/or ICA stenosis underwent a dual-source CT in dual-energy mode. Post-processing software selectively removed bone structures using the two energy data sets. Three-dimensional images with and without bone removal were reviewed and compared to DSA. Dual-energy bone removal was successful in all patients. For 10 patients, bone removal was good and CTA maximum-intensity projection (MIP) images could be used for vessel evaluation. For two patients, bone removal was moderate with some bone remnants, but this did not inhibit the three-dimensional visualization. Three aneurysms adjacent to the skull base were only partially visible in conventional CTA but were fully visible in DE-BR-CTA. In five patients with ICA stenosis, DE-BR-CTA revealed the stenotic lesions on the MIP images. The correlation between DSA and DE-BR-CTA was good (R (2)=0.822), but DE-BR-CTA led to an overestimation of stenosis. DE-BR-CTA was able to eliminate bone structure using only a single CT data acquisition and is useful to evaluate intracranial aneurysms and stenosis.