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array:24 [ "pii" => "S2173510718300351" "issn" => "21735107" "doi" => "10.1016/j.rxeng.2018.02.007" "estado" => "S300" "fechaPublicacion" => "2018-07-01" "aid" => "1049" "copyright" => "SERAM" "copyrightAnyo" => "2018" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Radiologia. 2018;60:310-7" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0033833818300456" "issn" => "00338338" "doi" => "10.1016/j.rx.2018.02.009" "estado" => "S300" "fechaPublicacion" => "2018-07-01" "aid" => "1049" "copyright" => "SERAM" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Radiologia. 2018;60:312-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 703 "formatos" => array:2 [ "HTML" => 598 "PDF" => 105 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">ORIGINAL</span>" "titulo" => "Utilidad de la tomografía computarizada de energía dual en la reducción del artefacto metálico generado por clips y <span class="elsevierStyleItalic">coils</span> intracraneales" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "312" "paginaFinal" => "319" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "The utility of dual-energy CT for metal artifact reduction from intracranial clipping and coiling" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1195 "Ancho" => 1569 "Tamanyo" => 189215 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Gráfico del nivel de ruido medio (UH) frente al nivel monoenergético de la reconstrucción (keV) comparando pacientes con clips (línea continua) y pacientes con <span class="elsevierStyleItalic">coils</span> (línea discontinua). Las diferencias fueron estadísticamente significativas (estrella) [<span class="elsevierStyleItalic">p</span> < 0,05].</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "D. Mera Fernández, E. Santos Armentia, A. Bustos Fiore, A.M. Villanueva Campos, E. Utrera Pérez, M. Souto Bayarri" "autores" => array:6 [ 0 => array:2 [ "nombre" => "D." "apellidos" => "Mera Fernández" ] 1 => array:2 [ "nombre" => "E." "apellidos" => "Santos Armentia" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Bustos Fiore" ] 3 => array:2 [ "nombre" => "A.M." "apellidos" => "Villanueva Campos" ] 4 => array:2 [ "nombre" => "E." "apellidos" => "Utrera Pérez" ] 5 => array:2 [ "nombre" => "M." "apellidos" => "Souto Bayarri" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173510718300351" "doi" => "10.1016/j.rxeng.2018.02.007" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173510718300351?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0033833818300456?idApp=UINPBA00004N" "url" => "/00338338/0000006000000004/v1_201807060918/S0033833818300456/v1_201807060918/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2173510718300387" "issn" => "21735107" "doi" => "10.1016/j.rxeng.2018.01.001" "estado" => "S300" "fechaPublicacion" => "2018-07-01" "aid" => "1054" "copyright" => "SERAM" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Radiologia. 2018;60:318-23" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Report</span>" "titulo" => "Radiation protection knowledge among radiologists in northwest Spain" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "318" "paginaFinal" => "323" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Conocimientos en materia de radioprotección en radiólogos del noroeste de España" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1327 "Ancho" => 1412 "Tamanyo" => 65404 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Use of bismuth protectors.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "D. Macía-Suárez, E. Sánchez-Rodríguez" "autores" => array:2 [ 0 => array:2 [ "nombre" => "D." "apellidos" => "Macía-Suárez" ] 1 => array:2 [ "nombre" => "E." "apellidos" => "Sánchez-Rodríguez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0033833818300778" "doi" => "10.1016/j.rx.2018.01.006" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0033833818300778?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173510718300387?idApp=UINPBA00004N" "url" => "/21735107/0000006000000004/v1_201807160417/S2173510718300387/v1_201807160417/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2173510718300326" "issn" => "21735107" "doi" => "10.1016/j.rxeng.2018.04.002" "estado" => "S300" "fechaPublicacion" => "2018-07-01" "aid" => "1022" "copyright" => "SERAM" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Radiologia. 2018;60:301-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Radiology through images</span>" "titulo" => "Perfusion defects in pulmonary perfusion iodine maps: Causes and semiology" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "301" "paginaFinal" => "309" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Defectos de perfusión en el mapa de iodo pulmonar: causas y semiología" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0035" "etiqueta" => "Figure 7" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr7.jpeg" "Alto" => 1124 "Ancho" => 1500 "Tamanyo" => 188900 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Fifty-four-year-old male with one mass in the left superior lobe. (a) Axial CTA image with mediastinum window showing one mass in the left superior lobe (white arrow). Axial (b) and coronal (c) reconstructions of the iodine map with absence of color that are consistent with the mass seen on the CTA image (white arrows).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Bustos Fiore, M. González Vázquez, C. Trinidad López, D. Mera Fernández, M. Costas Álvarez" "autores" => array:5 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Bustos Fiore" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "González Vázquez" ] 2 => array:2 [ "nombre" => "C." "apellidos" => "Trinidad López" ] 3 => array:2 [ "nombre" => "D." "apellidos" => "Mera Fernández" ] 4 => array:2 [ "nombre" => "M." "apellidos" => "Costas Álvarez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0033833817301935" "doi" => "10.1016/j.rx.2017.11.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0033833817301935?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173510718300326?idApp=UINPBA00004N" "url" => "/21735107/0000006000000004/v1_201807160417/S2173510718300326/v1_201807160417/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Report</span>" "titulo" => "The utility of dual-energy CT for metal artifact reduction from intracranial clipping and coiling" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "310" "paginaFinal" => "317" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "D. Mera Fernández, E. Santos Armentia, A. Bustos Fiore, A.M. Villanueva Campos, E. Utrera Pérez, M. Souto Bayarri" "autores" => array:6 [ 0 => array:4 [ "nombre" => "D." "apellidos" => "Mera Fernández" "email" => array:1 [ 0 => "danielmerafernandez@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "E." "apellidos" => "Santos Armentia" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "A." "apellidos" => "Bustos Fiore" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "A.M." "apellidos" => "Villanueva Campos" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "E." "apellidos" => "Utrera Pérez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "M." "apellidos" => "Souto Bayarri" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Departamento de Radiología, Hospital Povisa, Vigo, Pontevedra, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Diagnóstico por la Imagen, Hospital Universitari Dexeus, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Radiodiagnóstico, XXI de Santiago de Compostela, A Coruña, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Utilidad de la tomografía computarizada de energía dual en la reducción del artefacto metálico generado por clips y <span class="elsevierStyleItalic">coils</span> intracraneales" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 2202 "Ancho" => 2917 "Tamanyo" => 415266 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Patient with a clip in the supraclinoid segment of the right middle cerebral artery: progressive reduction of the amount of metal-induced susceptibility artifact with every increase in the kiloelectronvoltage of the reconstruction; the lowest noise ratio is obtained at 140<span class="elsevierStyleHsp" style=""></span>keV.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The prevalence of intracranial aneurysms in the adult population is around 2%<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">1</span></a> and they have been more and more diagnosed during the last few years following the boom in the use of non-invasive imaging modalities (computed tomography [CT] and magnetic resonance imaging [MRI]). The indication for its treatment depends on various factors. The direct occlusion of the aneurysmatic sac can be conducted via the endovascular route (with coils) or surgically (with clips). Then it is necessary to keep follow-up of these patients, being the MRI the modality of choice thanks to a less metal-induced susceptibility artifact, and because this imaging modality uses no ionizing radiation. However, at times, the MRI is contraindicated or cannot be conducted, and we have to choose other alternative techniques such as the CT scan or the conventional arteriography.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Metallic elements such as clips or coils within the exploratory area of CT scans can be an important cause of streak artifacts. These artifacts can block the correct visualization of the aneurysmatic sac treated and, even, the remaining arteries, which in turn is an important limitation to the diagnostic capabilities of these imaging modalities. That is why it is a priority to have tools available capable of minimizing this effect. Such artifacts are due to two (2) different mechanisms basically: the beam hardening phenomenon and the photon starvation phenomenon. The former one occurs because tissues preferably absorb low-energy photons when penetrated by polychromatic X-ray beams, that is, a beam with photons of different energy levels. This effect is even more consistent in high-attenuation regions like the bones, and when the X-ray beam penetrates structures with noticeable transitions of thickness and density. The photon starvation phenomenon takes place when X-ray beams penetrate a high-density element such as metal, that is, when the attenuation of such element is at its peak, and very few photons can penetrate it, leading to incomplete ranges of attenuation that are the cause of a false absorption halo that generates bands or images that have the appearance of “sunbeams”.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The metallic devices (clips and coils) used to repair aneurysms in cerebral arteries cause both effects and, therefore, are a source of streak artifacts in CT scan images.<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">2,3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The concept of dual-energy CT (DECT) was born during the development of the very first CT machines back in the decade of the 1970s, although in the daily practice it was used for the first time after the arrival of modern software and hardware tools.<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">4,5</span></a> DECT machines use two (2) different energy spectra through two (2) X-ray tubes simultaneously (dual-source CT scanner) or one singe tube (multilayer detectors where the detector can separate different energy photons from the emitted X-ray beam; and also ultrafast kilovoltage commutation where the tube can rapidly modulate the tension causing low and high-energy spectra). The main advantages of DECT are basically two. The first one being the characterization of materials based on different attenuations of the same element observed at two different energy levels (usually 80<span class="elsevierStyleHsp" style=""></span>kVp and 140<span class="elsevierStyleHsp" style=""></span>kVp). The second one is the possibility of generating virtual monoenergetic reconstructions where the image is seen as if acquired using one single-source CT scanner, that is, at a given kiloelectronvolt (keV).<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">5,6</span></a> As opposed to the attenuation values derived from the polychromatic spectrum of a conventional CT scanner, these monoenergetic reconstructions are free from the artifact that follows the beam hardening phenomenon. Therefore, it is said that the main benefits derived from using virtual monoenergetic images (VMI) are reducing the beam hardening phenomenon and providing more accurate measurements during the quantification of the attenuation values of different materials.<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">7,8</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The goals of this study were two: first, assess the reduction of metal-induced susceptibility artifacts due to intracranial clips and coils in angio CT scans of cerebral arteries using DECT with an image-based monoenergetic reconstruction algorithm; and second, study the different impact that such a reduction has on the different types of devices studied (clips and coils).</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and method</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Study population</span><p id="par0030" class="elsevierStylePara elsevierViewall">From September 2009 through September 2015, 147 patients underwent one angio CT scan of their cerebral arteries at our center. Among them, the data of 13 consecutive patients (9 men and 4 women; average age, 53.6 years; age range: 34–79 years) were retrospectively studied. Intracranial metallic devices were found to be associated with surgical or endovascular repairs of already known aneurysms (7 coils, 6 clips). All patients gave their informed consent prior to undergoing the angio CT scan. The hospital ethics committee approved the study design. All the patients with coils showed post-embolization changes in one anatomic location only (average volume of the embolization material 0.26<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">3</span>, range 0.09–0.47<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleSup">3</span>). All the patients with clips only had one clip by anatomic location. All patients had different contraindication to undergo the angio-MRI. All the examinations had been conducted following clinical indications: to control one embolized aneurysm (5 out of 13), for the postoperative control of an aneurysm treated with a clip (5 out of 13), to rule out subarachnoid hemorrhage in one patient with a coil (1 out of 13), and due to headache (2 out of 13; one patient with a clip and another with a coil). The same DECT protocol of acquisition was used.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Study protocol</span><p id="par0035" class="elsevierStylePara elsevierViewall">All studies were conducted using one dual-energy CT scanner (Somatom Definition Flash, Siemens Medical Solutions<span class="elsevierStyleSup">®</span>, Forchheim, Germany), integrated by two (2) X-ray tubes working at different energy levels (tube A: 80<span class="elsevierStyleHsp" style=""></span>kVp at 252<span class="elsevierStyleHsp" style=""></span>mAs; tube B: 140<span class="elsevierStyleHsp" style=""></span>kVp at 126<span class="elsevierStyleHsp" style=""></span>mAs). The high-energy tube also integrates tin filtration (Sn) to be able to eliminate low-energy photons from the X-ray beam in an attempt to reduce the dose of radiation used and obtain better spectral analysis of the images. The remaining parameters of the examination were: tube rotation time 0.28<span class="elsevierStyleHsp" style=""></span>ms; detector collimation 20<span class="elsevierStyleHsp" style=""></span>mm; slice thickness 64<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>0.3<span class="elsevierStyleHsp" style=""></span>mm; pitch 0.9.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The studies were acquired starting at C2 all the way toward the cranial vertex after the continuous injection of 90<span class="elsevierStyleHsp" style=""></span>mL of a nonionic, low osmolarity contrast agent at a concentration of 300<span class="elsevierStyleHsp" style=""></span>mg/dL (Iopromida, Ultravist 300, Bayer<span class="elsevierStyleSup">®</span>) via the antecubital vein of the arm, at a flow rate of 4<span class="elsevierStyleHsp" style=""></span>mL/s followed by one bolus of 50<span class="elsevierStyleHsp" style=""></span>mL of saline solution using one dual siringe spike infection system (Medrad Stellant<span class="elsevierStyleSup">®</span> dual siringe spike CT injection system). The acquisition of data was initiated using the bolus tracking technique being the region of interest (ROI) located in the ascending aorta and the trigger threshold set at 100 Hounsfield units (HU).</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Imaging reconstruction</span><p id="par0045" class="elsevierStylePara elsevierViewall">For image reconstruction purposes, one reconstruction filter of soft tissues was used (homogeneous D20f). The axial images were reconstructed with 1<span class="elsevierStyleHsp" style=""></span>mm-thick cut by adjusting the field of vision manually in order to include the entire skull.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Image postprocessing was conducted using software available in the market (Syngo Via, Siemens Healthcare<span class="elsevierStyleSup">®</span>, Forchheim, Germany) and one image-based monoenergetic reconstruction algorithm. The images from all patients were postprocessed manually and monoenergetic virtual reconstructions from 40<span class="elsevierStyleHsp" style=""></span>keV up to a level of 150<span class="elsevierStyleHsp" style=""></span>keV were acquired, at 10<span class="elsevierStyleHsp" style=""></span>keV intervals resulting in 12 different energy levels per patient and study.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Data analysis</span><p id="par0055" class="elsevierStylePara elsevierViewall">The metal-induced susceptibility artifact was objectively assessed by calculating the noise ratio (HU) within one circular ROI of 1<span class="elsevierStyleHsp" style=""></span>cm in diameter identically placed at the region of maximum metal-induced susceptibility artifact for each and every one of the 12 monoenergetic reconstructions. The noise ratio within the ROI was estimated as the standard deviation to the average of all attenuation values within the ROI.</p><p id="par0060" class="elsevierStylePara elsevierViewall">One subjective assessment of the artifact was conducted too. Two (2) independent radiologists (one 3rd-year resident in radiodiagnosis, and one radiologist with 10 years of experience in neuroradiology) assessed the amount of metal-induced susceptibility artifact per patient in each monoenergetic level. With this goal in mind, one 5-point arbitrary score was used: 1 point, artifact that completely blocks any kind of visualization; 2 points, artifact that blocks visualization almost entirely; 3 points, presence of some artifact that allows visualization; 4 points, scarce artifact; 5 points, total lack of artifact.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Lastly, the different behavior shown by the two (2) different types of metallic devices studied (clips and coils) compared to the amount of artifact generated in different monoenergetic reconstructions was assessed. Consequently, a comparison was made of the noise ratios (HU) previously obtained between the group of patients with clips and the group of patients with coils. Similarly, the score obtained during the subjective assessment of the artifact was compared between the two groups (clips and coils).</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Statistical analysis</span><p id="par0070" class="elsevierStylePara elsevierViewall">The statistical analysis of data was conducted using software available in the market (SPSS for Windows, version 19; SPSS/IBM, Chicago, Illinois, USA). Once the normalcy of noise ratio distribution was confirmed using the Kolmogórov–Smirnov test and the Shapiro–Wilk test, the differences found at each energy level were studied using the ANOVA test and the Games–Howell post hoc test. In order to compare the differences found between clips and coils, the Mann–Whitney test was used. The degree of interobserver agreement with respect to the amount of metal-induced susceptibility artifact was determined using the kappa (<span class="elsevierStyleItalic">κ</span>) statistical analysis. <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05 was considered statistically significant.</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Results</span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Objective assessment of noise generated by metal-induced susceptibility artifacts</span><p id="par0075" class="elsevierStylePara elsevierViewall">The lowest noise ratio obtained for all 13 patients studied was observed at 130<span class="elsevierStyleHsp" style=""></span>keV (43<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>33<span class="elsevierStyleHsp" style=""></span>HU), and the highest noise ratio at 40<span class="elsevierStyleHsp" style=""></span>keV (179.3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>95<span class="elsevierStyleHsp" style=""></span>HU), with statistically significant differences for noise ratios at the different monoenergetic levels observed (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001). The Games–Howell post hoc test showed that the noise ratios of reconstructions with lower energies (40–60<span class="elsevierStyleHsp" style=""></span>keV) were different from the noise ratios of reconstructions with higher energies (70–150<span class="elsevierStyleHsp" style=""></span>keV), and these were statistically significant differences (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Subjective assessment of noise generated by metal-induced susceptibility artifacts</span><p id="par0080" class="elsevierStylePara elsevierViewall">The iterobserver agreement when it comes to the subjective assessment of noise was good (<span class="elsevierStyleItalic">κ</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.72). <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows scores from both observers when it comes to the imaging quality of intracranial arteries with clips and coils at different reconstruction intervals – results that were consistent with those obtained in the quantitative analysis.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Differences seen on the type of device analyzed</span><p id="par0085" class="elsevierStylePara elsevierViewall">Noise was increased in the group of patients with coils compared to the group of patients with clips (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001) (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">Also, the reduced noise ratio obtained with every energy increase during reconstruction was greater in the group of patients with clips than in the group of patients with coils (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>) where, yet despite the progressive increase of energy levels, no significant reduction in the amount of noise was reported, and this different behavior was statistically significant (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05) (<a class="elsevierStyleCrossRefs" href="#fig0015">Figs. 3 and 4</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Discussion</span><p id="par0095" class="elsevierStylePara elsevierViewall">The use of VMI in studies of cerebral arteries obtained using DECT can be of great utility since, as it has already been confirmed and published for other vascular territories, one image-based monoenergetic reconstruction algorithm (to low keV) increases the degree of vascular opacity inside the blood vessels, thus improving visualization.<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">9,10</span></a> Also, the use of VMI gives us an extra advantage because VMI reduce streak artifacts in patients with metallic devices by using one reconstruction algorithm with high monoenergetic values (VMI at high keV). This has already been confirmed in former studies on postoperative images of the spine, orthopedic and trauma surgery.<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">11–13</span></a> We have only found one study that analyzes this effect in patients with intracranial metallic devices,<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">14</span></a> but it is just a visual analysis and does no include patients with clips, so it does not really study the different impact made based on the type of device studied.</p><p id="par0100" class="elsevierStylePara elsevierViewall">The results shown here prove that, same as it happens in other anatomical locations, the use of VMI at high keV reduces significantly the metal-induced susceptibility artifact of intracranial devices (clips and coils).</p><p id="par0105" class="elsevierStylePara elsevierViewall">The subjective image noise score has good interobserver agreement and adequate consistency with the results from the quantitative analysis, suggestive that the results obtained are exact and reproducible. We found that the lowest noise ratio of areas with structures with metallic density occurs at a 70–150<span class="elsevierStyleHsp" style=""></span>keV range and proved that the use of VMI at 130<span class="elsevierStyleHsp" style=""></span>keV exhibits the lowest noise ratio, especially in patients with clips. To our surprise, we found that this effect was exactly like that, particularly, in the group of patients with clips. Patients with coils were less vulnerable to changes in the selection of the energy level. In this sense, we should bear in mind that metal-induced susceptibility artifacts depend on many factors, such as the composition of the metallic device (titanium in the case of clips, and platinum in the case of coils), or the orientation of the implant; maybe this is why in a coil, that has a ball-like structure, the artifact is more evident or more difficult to find than it is in a clip, that has one single orientation.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">2</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">Therefore, the use of DECT with an image-based monoenergetic reconstruction algorithm for the study of cerebral arteries has a double advantage: on the one hand, it allows us to enhance the contrast of blood vessels using VMI at low keV; on the other hand, it reduces the metal-induce susceptibility artifact using VMI at high keV; all this improves significantly the quality of such studies. In this sense, we believe that, in centers with technical availability, the follow-up of patients with intracranial clips and coils who are non-eligible to undergo angio-MRI studies should be conducted through DECT and virtual monoenergetic images. Having in mind the lower reduction of artifacts observed in patients with coils, this technique should be saved for patients surgically treated with clips, which means that we still need to find other imaging modalities and upgraded software packages for the reduction of artifacts that can be generalized to all patients.</p><p id="par0115" class="elsevierStylePara elsevierViewall">This study has two (2) limitations basically. On the one hand, the scarce number of participants. Taking this into consideration, we should bear in mind that although the digital subtraction angiography is still the standard of reference for the follow-up of patients with treated aneurysms, tomographic imaging modalities such as the angio-CT scanner and the angio-MRI are the ones commonly used in the daily routine practice for the control of these patients<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">15</span></a>; particularly, the angio-MRI is the preferred imaging modality due to its higher sensitivity for the detection of residual fluid inside the aneurysm and because it does not use ionizing radiation.<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">16–19</span></a> This has been decisive when it comes to establishing the reduced final number of participants in our study. We did not analyze either the impact that modifying the energy level has on the signal-noise ratio (SNR) and the contrast-noise ratio (CNR) in the lumen of the remaining cerebral arteries because we thought this had already been discussed and published in the medical literature.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">9</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">In sum, the use of DECT with virtual monoenergetic images in patients treated with intracranial clips promises encouraging results since it significantly reduces the amount of streak artifacts and improves the imaging quality of angio-CT studies of the cerebral arteries, being this effect less significant in patients treated with coils.</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Authors</span><p id="par0125" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1.</span><p id="par0130" class="elsevierStylePara elsevierViewall">Manager of the integrity of the study: DMF, ESA, MSB</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2.</span><p id="par0135" class="elsevierStylePara elsevierViewall">Study idea: DMF, ESA</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3.</span><p id="par0140" class="elsevierStylePara elsevierViewall">Study design: DMF, ESA</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4.</span><p id="par0145" class="elsevierStylePara elsevierViewall">Data mining: DMF, ESA, ABF, AMVC, EUP</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">5.</span><p id="par0150" class="elsevierStylePara elsevierViewall">Data analysis and interpretation: DMF, ESA, ABF, AMVC, EUP</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">6.</span><p id="par0155" class="elsevierStylePara elsevierViewall">Statistical analysis DMF, ESA</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">7.</span><p id="par0160" class="elsevierStylePara elsevierViewall">Reference: DMF, ESA, ABF, AMVC, EUP</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">8.</span><p id="par0165" class="elsevierStylePara elsevierViewall">Writing: DMF, ESA, MSB</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">9.</span><p id="par0170" class="elsevierStylePara elsevierViewall">Critical review of the manuscript with intellectually relevant remarks: DMF, ESA, MSB</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">10.</span><p id="par0175" class="elsevierStylePara elsevierViewall">Approval of final version: DMF, ESA, ABF, AMVC, EUP, MSB</p></li></ul></p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conflicts of interests</span><p id="par0180" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interests associated with this article whatsoever.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres1060312" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Materials and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1009159" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1060311" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1009160" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Material and method" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Study population" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Study protocol" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Imaging reconstruction" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Data analysis" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Statistical analysis" ] ] ] 6 => array:3 [ "identificador" => "sec0040" "titulo" => "Results" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0045" "titulo" => "Objective assessment of noise generated by metal-induced susceptibility artifacts" ] 1 => array:2 [ "identificador" => "sec0050" "titulo" => "Subjective assessment of noise generated by metal-induced susceptibility artifacts" ] 2 => array:2 [ "identificador" => "sec0055" "titulo" => "Differences seen on the type of device analyzed" ] ] ] 7 => array:2 [ "identificador" => "sec0060" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0065" "titulo" => "Authors" ] 9 => array:2 [ "identificador" => "sec0070" "titulo" => "Conflicts of interests" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-08-16" "fechaAceptado" => "2018-02-25" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1009159" "palabras" => array:3 [ 0 => "Neuroimaging" 1 => "Intracranial aneurysm" 2 => "Artifacts" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1009160" "palabras" => array:3 [ 0 => "Neuroimagen" 1 => "Aneurisma intracraneal" 2 => "Artefactos" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To assess the ability of dual-energy CT (DECT) to reduce metal-related artifacts in patients with clips and coils in head CT angiography, and to analyze the differences in this reduction between both type of devices.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Materials and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Thirteen patients (6 clips, 7 coils) were selected and retrospectively analyzed. Virtual monoenergetic images (MEI) with photon energies from 40 to 150<span class="elsevierStyleHsp" style=""></span>keV were obtained. Noise was measured at the area of maximum artifact. Subjective evaluation of streak artifact was performed by two radiologists independently. Differences between noise values in all groups were tested by using the ANOVA test. Mann–Whitney <span class="elsevierStyleItalic">U</span> test was used to compare the differences between clips and coils. Cohen's <span class="elsevierStyleItalic">κ</span> statistic was used to determine interobserver agreement.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The lowest noise value was observed at high energy levels (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05). Noise was higher in the coil group than in the clip group (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001). Interobserver agreement was good (<span class="elsevierStyleItalic">κ</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.72).</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">TCED with MEI helps to minimize the artifact from clips ands coils in patients who undergo head CT angiography. The reduction of the artifact is greater in patients with surgical clipping than in patients with endovascular coiling.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Materials and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Evaluar la capacidad de la TC de energía dual (TCED) para reducir el artefacto metálico en pacientes con clips y <span class="elsevierStyleItalic">coils</span> intracraneales en estudios de angio-TC cerebral, y analizar el diferente impacto que dicha reducción tiene en función del tipo de dispositivo estudiado.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se analizaron retrospectivamente 13 pacientes (6 clips, 7 <span class="elsevierStyleItalic">coils</span>). Se obtuvieron imágenes virtuales monoenergéticas (IVM) en un rango de 40 a 150 keV. Se midió el ruido dentro del área de máximo artefacto. La evaluación subjetiva del ruido fue realizada independientemente por dos radiólogos. Las diferencias encontradas se evaluaron mediante el test ANOVA. El test Mann-Whitney se utilizó para comparar las diferencias entre clips y <span class="elsevierStyleItalic">coils</span>. Se determinó el grado de concordancia interobservador (coeficiente κ).</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">El ruido fue más bajo en los niveles energéticos más altos (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,05). El ruido fue mayor en pacientes con <span class="elsevierStyleItalic">coils</span> (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,001). La correlación interobservador fue buena (κ<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,72).</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El uso de TCED con reconstrucciones virtuales monoenergéticas ayuda a minimizar el artefacto producido por clips y <span class="elsevierStyleItalic">coils</span> intracraneales en estudios de angio-TC cerebral. La reduccción del artefacto conseguida es mayor en el grupo de pacientes con clips que en el grupo de pacientes con <span class="elsevierStyleItalic">coils</span>.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Mera Fernández D, Santos Armentia E, Bustos Fiore A, Villanueva Campos AM, Utrera Pérez E, Souto Bayarri M. Utilidad de la tomografía computarizada de energía dual en la reducción del artefacto metálico generado por clips y<span class="elsevierStyleItalic">coils</span> intracraneales. Radiología. 2018;60:312–319.</p>" ] ] "multimedia" => array:6 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1274 "Ancho" => 1603 "Tamanyo" => 102536 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Distribution of noise ratio (HU) based on the monoenergetic level of reconstruction. Statistically significant difference confirmed (asterisk) between reconstructions with the lowest energies (40–60<span class="elsevierStyleHsp" style=""></span>keV) and reconstructions with the highest energies (70–150<span class="elsevierStyleHsp" style=""></span>keV).</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1195 "Ancho" => 1569 "Tamanyo" => 187834 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Noise ratio chart (HU) and monoenergetic level of reconstruction (keV) in patients with clips (continuous line) and patients with coils (dotted line). Differences were statistically significant (asterisk) [<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05].</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 2202 "Ancho" => 2917 "Tamanyo" => 415266 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Patient with a clip in the supraclinoid segment of the right middle cerebral artery: progressive reduction of the amount of metal-induced susceptibility artifact with every increase in the kiloelectronvoltage of the reconstruction; the lowest noise ratio is obtained at 140<span class="elsevierStyleHsp" style=""></span>keV.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 2197 "Ancho" => 2917 "Tamanyo" => 469058 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Patient with a coil in the top of basilary artery: early reduction of metal-induced susceptibility artifact confirmed up to a level of around 100<span class="elsevierStyleHsp" style=""></span>keV, where inspite of every virtual increase of the monoenergetic value, no significant noise reduction was achieved.</p>" ] ] 4 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">1: artifact that completely blocks any kind of visualization; 2: artifact that blocks visualization almost entirely; 3: presence of some artifact that allows visualization; 4: scarce artifact; 5: total lack of artifact.</p><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">keV: kiloelectronvolt (monoenergetic level of reconstruction).</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">40<span class="elsevierStyleHsp" style=""></span>keV \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">50<span class="elsevierStyleHsp" style=""></span>keV \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">60<span class="elsevierStyleHsp" style=""></span>keV \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">70<span class="elsevierStyleHsp" style=""></span>keV \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">80<span class="elsevierStyleHsp" style=""></span>keV \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">90<span class="elsevierStyleHsp" style=""></span>keV \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">100<span class="elsevierStyleHsp" style=""></span>keV \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">110<span class="elsevierStyleHsp" style=""></span>keV° \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">120<span class="elsevierStyleHsp" style=""></span>keV \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">130<span class="elsevierStyleHsp" style=""></span>keV \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">140<span class="elsevierStyleHsp" style=""></span>keV \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">150<span class="elsevierStyleHsp" style=""></span>keV \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="12" align="left" valign="top"><span class="elsevierStyleBold">Clips</span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="12" align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Radiologist #1/Radiologist #2</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; 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entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>1/1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1/1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1/1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2/2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2/2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3/3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3/3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3/3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3/3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3/3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2/3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3/3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>1/1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1/2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2/3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2/3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3/4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4/4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4/4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5/4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5/4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5/4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4/4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4/4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="12" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="12" align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Coils</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; 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entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>1/1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1/1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1/1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1/1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1/1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1/1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1/1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1/1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1/1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1/1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1/1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1/1 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1804567.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Imaging quality score for all the patients in each of the 12 monoenergetic levels according to two (2) independent radiologists.</p>" ] ] 5 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Data are expressed in Hounsfield units (HU) as mean<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>standard deviation.</p><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">keV: kiloelectronvolt (monoenergetic level of reconstruction).</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">40<span class="elsevierStyleHsp" style=""></span>keV \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">50<span class="elsevierStyleHsp" style=""></span>keV \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">60<span class="elsevierStyleHsp" style=""></span>keV \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">70<span class="elsevierStyleHsp" style=""></span>keV \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">80<span class="elsevierStyleHsp" style=""></span>keV \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">90<span class="elsevierStyleHsp" style=""></span>keV \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">100<span class="elsevierStyleHsp" style=""></span>keV \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">110<span class="elsevierStyleHsp" style=""></span>keV° \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">120<span class="elsevierStyleHsp" style=""></span>keV \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">130<span class="elsevierStyleHsp" style=""></span>keV \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">140<span class="elsevierStyleHsp" style=""></span>keV \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">150<span class="elsevierStyleHsp" style=""></span>keV \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Clips</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">252.5 (±87) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">163.8 (±68) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">106 (±48) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">69.8 (±34) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">47.6 (±24) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34 (±18) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26 (±13) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21.8 (±9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20.5 (±9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19.8 (±5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20.1 (±4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20.6 (±4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Coils</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">116, 5(±41) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">84.3 (±37) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">70.3 (35) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">64.7 (±34) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">63 (±34) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">62.8 (±34) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">63.2 (±34) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">63.5 (±34) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">64 (±34) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">64.4 (±34) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">64.5 (±34) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">65 (±34) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1804568.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Average noise ratios observed for the two (2) subgroups of patients in each of the 12 monoenergetic levels studied.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:19 [ 0 => array:3 [ "identificador" => "bib0100" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence and risk of rupture of intracranial aneurysms: a systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "G.J. 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