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Research ArticleInterventional

Imaging Artifacts of Liquid Embolic Agents on Conventional CT in an Experimental in Vitro Model

N. Schmitt, R.O. Floca, D. Paech, R.A. El Shafie, F. Seker, M. Bendszus, M.A. Möhlenbruch and D.F. Vollherbst
American Journal of Neuroradiology January 2021, 42 (1) 126-131; DOI: https://doi.org/10.3174/ajnr.A6867
N. Schmitt
aFrom the Departments of Neuroradiology (N.S., F.S., M.B., M.A.M., D.F.V.)
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R.O. Floca
bRadiation Oncology (R.O.F., R.A.E.S.), Heidelberg University Hospital, Heidelberg, Germany
cMedical and Biological Informatics (R.O.F.)
eHeidelberg Institute for Radiation Oncology and National Center for Radiation Research in Oncology (R.O.F.), Heidelberg, Germany
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D. Paech
dDepartment of Radiology (D.P.), German Cancer Research Center, Heidelberg, Germany
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R.A. El Shafie
bRadiation Oncology (R.O.F., R.A.E.S.), Heidelberg University Hospital, Heidelberg, Germany
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F. Seker
aFrom the Departments of Neuroradiology (N.S., F.S., M.B., M.A.M., D.F.V.)
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M. Bendszus
aFrom the Departments of Neuroradiology (N.S., F.S., M.B., M.A.M., D.F.V.)
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M.A. Möhlenbruch
aFrom the Departments of Neuroradiology (N.S., F.S., M.B., M.A.M., D.F.V.)
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D.F. Vollherbst
aFrom the Departments of Neuroradiology (N.S., F.S., M.B., M.A.M., D.F.V.)
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  • FIG 1.
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    FIG 1.

    Schematic illustration of the donut-shaped ROI created by the MITK with an inner radius of 6 mm and an outer radius of 26 mm. The tube filled with the LEA of interest was placed centrally with a radius equal to the radius of the donut hole. For each tube, the measurement was performed with an ROI in 5 different positions according to the length of the LEA cast.

  • FIG 2.
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    FIG 2.

    Illustration of the results of the quantitative image analysis. Different degrees of artifacts were observed among all study groups. Post hoc testing showed differences among the different types of LEAs (eg, Squid 18 versus PHIL 25% and Squid 12 versus PHIL LV). Bars indicate mean; whiskers, SD.

  • FIG 3.
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    FIG 3.

    Representative CT images in the axial plane in a standard brain window with a width of 80 and a length of 40. Note the more severe artifacts for the EVOH-based LEAs (Onyx and Squid) and the relatively low degree of artifacts for LEAs that used iodine as a radiopaque component (PHIL and n-BCA/iodized oil).

  • FIG 4.
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    FIG 4.

    Illustration of the results of the qualitative image analysis using a 5-point scale. Different degrees of artifacts were observed among all study groups using the Dunn test for multiple comparisons with statistical hypothesis testing. Bars indicate mean; whiskers, SD. Five-point scale: 1) severe artifacts, 2) marked artifacts, 3) moderate artifacts, 4) minor artifacts, and 5) no artifacts.

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    Table 1:

    Summary of the quantitative imaging analysis

    Liquid Embolic AgentSD of Donut-Shaped ROIP Valuea
    Onyx 1856.6 ± 20.1 HU
    Squid 1830.3 ± 9.7 HU
    Squid 18 LD18.5 ± 6.8 HU
    Squid 1233.4 ± 17.3 HU
    Squid 12 LD19.4 ± 7.7 HUP < .001
    PHIL 25%10.6 ± 0.8 HU
    PHIL LV10.1 ± 0.9 HU
    n-BCA/iodized oil11.9 ± 1.0 HU
    Saline5.1 ± 0.1 HU
    • ↵a Kruskal-Wallis test; for the P values of the post hoc analysis, see Table 2.

    • View popup
    Table 2:

    Summary of the results of the post hoc Dunn test for the quantitative analysis

    Liquid Embolic AgentOnyx 18Squid 18Squid 18 LDSquid 12Squid 12 LDPHIL 25%PHIL LVn-BCA/Iodized Oil
    SalineP < .001aP < .001aP < .001aP < .001aP < .001aP = .001aP = .034aP < .001a
    n-BCA/iodized oilP < .001aP < .001aP = .106P < .001aP = .468P = .987P = .096
    PHIL LVNANANAP < .001NAP > .999
    PHIL 25%P < .001aP < .001aNANANA
    Squid 12 LDNANAP > .999P = .013a
    Squid 12NAP > .999NA
    Squid 18 LDNAP = .057
    Squid 18P = .118
    • Note:—NA indicates no P value available because the Dunn test was only performed for corresponding LEA variants.

    • ↵a Statistical significance.

    • View popup
    Table 3:

    Summary of the results of the post hoc Dunn test for the qualitative analysis

    Liquid Embolic AgentOnyx 18Squid 18Squid 18 LDSquid 12Squid 12 LDPHIL 25%PHIL LVn-BCA/Iodized Oil
    SalineP < .001aP < .001aP = .022aP < .001aP = .009aP = .665P = .665P = .665
    n-BCA/iodized oilP < .001aP = .004aP > .999P = .003aP > .999P > .999P > .999
    PHIL LVNANANAP = .003aNAP > .999
    PHIL 25%P < .001aP = .004aNANANA
    Squid 12 LDNANAP > .999P = .311
    Squid 12NAP > .999NA
    Squid 18 LDNAP = .201
    Squid 18P > .999
    • Note:—NA indicates no P value available because the Dunn test was performed for only corresponding LEA variants.

    • ↵a Statistical significance.

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Cite this article
N. Schmitt, R.O. Floca, D. Paech, R.A. El Shafie, F. Seker, M. Bendszus, M.A. Möhlenbruch, D.F. Vollherbst
Imaging Artifacts of Liquid Embolic Agents on Conventional CT in an Experimental in Vitro Model
American Journal of Neuroradiology Jan 2021, 42 (1) 126-131; DOI: 10.3174/ajnr.A6867

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Imaging Artifacts of Liquid Embolic Agents on Conventional CT in an Experimental in Vitro Model
N. Schmitt, R.O. Floca, D. Paech, R.A. El Shafie, F. Seker, M. Bendszus, M.A. Möhlenbruch, D.F. Vollherbst
American Journal of Neuroradiology Jan 2021, 42 (1) 126-131; DOI: 10.3174/ajnr.A6867
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