Fundamental study of the energy subtraction process using a monochromatic image for computed tomography angiography after coil embolization of a cerebral aneurysm

: Coil-embolized cerebral aneurysms are difficult to evaluate using computed tomography (CT) angiography (CTA) due to artifacts caused by the coil devices. This study was conducted to assess the practicality of energy subtraction processing using monochromatic images obtained using CTA after coil embolization of a cerebral aneurysm. In this study, the changes in the CT value of the contrast agent and the coil were analyzed not only at varying monochromatic energy levels but also by energy subtraction processing. Our analyses revealed an exponential change in the CT value of the contrast agent at any desired energy. We also found that the CT value of the coil was unchanged at the upper threshold of the grayscale limit. Based on these results, we were able to create images of changes in material-specific CT values and thus eliminate the material. Energy subtraction processing enabled us to distinguish between the contrast agent, the coil, and the artifacts from coil devices. We suggest that energy subtraction processing using monochromatic images can resolve the limitations of CTA after coil embolization of cerebral aneurysms.