SIR 2024
Embolization
Steven Meng, MD
Resident
University of Texas Southwestern Medical Center
Financial relationships: Full list of relationships is listed on the CME information page.
Ali Shaikh
Medical Student
Texas College of Osteopathic Medicine
Financial relationships: Full list of relationships is listed on the CME information page.
Hamed Alattar, MD (he/him/his)
Resident
University of Texas Southwestern Medical Center
Financial relationships: Full list of relationships is listed on the CME information page.
Triet Do, MD
Resident Physician - Interventional Radiology
University of Texas Southwestern Medical Center
Disclosure information not submitted.
Fatima Khan, DO
Resident
University of Texas Southwestern Medical Center
Disclosure information not submitted.
Liqiang Ren, PhD
Assistant Professor
University of Texas Southwestern Medical Center
Disclosure information not submitted.
Richard Ahn, MD
Assistant Professor
University of Texas Southwestern Medical Center
Disclosure information not submitted.
Todd Soesbe, PhD
Assistant Professor
University of Texas Southwestern Medical Center
Disclosure information not submitted.
Anil K. Pillai, MD
Section Chief
University of Texas Southwestern
Disclosure information not submitted.
Pulmonary arteriovenous malformations (PAVMs) are vascular abnormalities characterized by direct communication between pulmonary arteries and veins and are commonly associated with hereditary hemorrhagic telangiectasia (HHT) {1}. Percutaneous transcatheter embolization using coils and plugs has been established as a primary intervention for the management of PAVMs, offering effective occlusion of the feeding arteries. PAVM patients are followed post-procedurally with interval CT angiography (CTA) to identify potential signs of recanalization {2-4}. CTAs are often compromised by artifacts produced by coils and plugs that limit effective evaluation for recanalization {5}. Photon-counting CT (PCCT) is a new CT imaging modality with a unique ability to provide ultra-high spatial resolution (0.2-mm). Spectral information intrinsic to PCCT can also be used for post-processing techniques to minimize metal artifacts, create monoenergetic images, and differentiate iodine from artifacts caused by the embolic agent or devices {6-7}.
Clinical Findings/Procedure Details: In this exhibit, we explain the physics behind PCCT pertaining to reducing metallic artifacts encountered in vascular imaging. We use a sample patient scanned with PCCT to demonstrate its benefits in post-embolization assessment of PAVM patients when used in conjunction with post-scan reformatting through iterative metal artifact reduction (iMAR) and manipulation of monoenergetic image keV levels. We troubleshoot and confirm selective filtering of metallic artifacts. An overview of other techniques to reduce metallic artifact will be presented and compared to PCCT in a tabular format.
Conclusion and/or Teaching Points:
PCCT is a promising tool to better visualize and distinguish intravascular contrast from metal artifacts for patients’ status post embolization of PAVM. There are a variety of troubleshooting techniques available through different keV and iMAR settings to diminish artifacts while highlighting vasculature. This educational abstract will enable the viewer to understand the utility of PCCT and compare other conventional metallic artifact reducing techniques for effective management of patients with PAVM.