Role of spectral-detector CT in reduction of artifacts from contrast media in axillary and subclavian veins: single institution study in 50 patients

Background: In CT imaging, a high concentration of iodinated contrast media in axillary and subclavian veins after brachial application can cause perivenous artifacts impairing diagnostic assessment of local vascular structures and soft tissue. Purpose: To investigate reduction of perivenous hypo- and hyperattenuating artifacts of the axillary and subclavian veins using virtual monoenergetic images (VMI) in comparison to conventional CT images (CI), acquired on spectral-detector CT. Material and Methods: 50 spectral-detector CT datasets of patients with perivenous artifacts from contrast media were included in this retrospective, institutional review board-approved study. CT images and virtual monoenergetic images (range 40–200 keV, 10-keV increments) were reconstructed from the same scans. Quantitative analysis was performed by region of interest-based assessment of mean attenuation (HU) and standard deviation in most pronounced hypo- and hyperdense artifacts and artifact-impaired arteries as well as muscle. Visually, artifact reduction, assessment of vessels, and surrounding soft tissue were rated on 5-point Likert-scales by two radiologists. Results: In comparison to CT images, virtual monoenergetic images of ≥90 keV showed a significant reduction of hypo- and hyperattenuating artifacts (hypodense: CI -220.0±171.2 HU; VMI_130keV -13.4±49.1 HU; hyperdense: CI 274.6±184.4 HU; VMI_130keV 24.2±84.9 HU; P<0.001). Subjective analysis confirmed that virtual-monoenergetic images of ≥100 keV significantly reduced artifacts (hypodense: CI 2[1–3]; VMI_130keV 5[4–5], hyperdense: CI 2[1–4]; VMI_130keV 5[5–5], P<0.001) and improved diagnostic assessment. Best results for diagnostic assessment were noted for virtual monoenergetic images at 130 keV. Overcorrection of artifacts was observed at higher keV values. Interrater agreement was excellent for each evaluation and keV value (intraclass correlation coefficient 0.89). Conclusion: Higher keV virtual monoenergetic images yielded significant reduction of contrast media artifacts and led to improved assessment of vessels and surrounding soft tissue. Recommended keV values for best diagnostic assessment are in the range of 100–160 keV.