{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T23:45:05Z","timestamp":1792799105302,"version":"4.5.0"},"reference-count":25,"publisher":"Springer Science and Business Media LLC","issue":"3","license":[{"start":{"date-parts":[[2025,2,6]],"date-time":"2025-02-06T00:00:00Z","timestamp":1738800000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,2,6]],"date-time":"2025-02-06T00:00:00Z","timestamp":1738800000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Universit\u00e4tsklinikum Augsburg"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Clin Neuroradiol"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Purpose<\/jats:title>\n            <jats:p>In vitro differentiation of iodine and tantalum-based liquid embolics post-embolization can be achieved using spectral computed tomography. This study evaluates the in vivo ability of clinical photon-counting computed tomography (PCD-CT) to distinguish these embolic agents in patients undergoing endovascular treatments for cerebrovascular and spinal pathologies.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>This retrospective study included 25\u00a0patients treated between April 2021 and March 2024, who underwent PCD-CT imaging post-embolization for intracranial arteriovenous malformations (AVM), dural arteriovenous fistulas (dAVF), spinal tumors, or middle meningeal artery (MMA) embolization for chronic subdural hematomas (cSDH). Imaging analysis involved iterative reconstruction, using conventional images (CI), iodine maps (IM), and virtual non-contrast (VNC) series. Two blinded neuroradiologists assessed the suppression quality of the embolic agents on a\u00a0Likert scale.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Of the 25\u00a0patients, 22\u00a0underwent intracranial and 3\u00a0spinal embolizations. The differentiation between iodine and tantalum-based embolics achieved 92% accuracy for reader 1\u00a0and 88% for reader\u00a02, with a\u00a0Cohen\u2019s kappa coefficient of 0.92 indicating high inter-reader agreement. Iodine-based agents were moderately suppressed, whereas tantalum-based agents exhibited superior suppression. Errors arose from mistaking suppressed platinum coils for tantalum-based embolics. Hemorrhage detection accuracy was high, with a\u00a0Cohen\u2019s kappa of\u00a00.92.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>PCD-CT effectively differentiates between iodine- and tantalum-based embolics in vivo, demonstrating high diagnostic accuracy and inter-reader reliability. This capability facilitates improved post-procedural assessment and may enhance the management of endovascularly treated patients by reducing imaging artifacts and aiding in hemorrhage detection.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s00062-025-01502-x","type":"journal-article","created":{"date-parts":[[2025,2,6]],"date-time":"2025-02-06T12:53:50Z","timestamp":1738846430000},"page":"443-450","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["In Vivo Discrimination of Iodine and Tantalum-Based Liquid Embolics After Intracranial or Spinal Embolization Using Photon-Counting Detector CT"],"prefix":"10.1007","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0305-0797","authenticated-orcid":false,"given":"Christoph Johannes","family":"Maurer","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5321-5118","authenticated-orcid":false,"given":"Ansgar","family":"Berlis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-6347-7580","authenticated-orcid":false,"given":"Franz Josef","family":"Stangl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3221-6055","authenticated-orcid":false,"given":"Lars","family":"Behrens","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,2,6]]},"reference":[{"key":"1502_CR1","doi-asserted-by":"publisher","first-page":"1118","DOI":"10.1136\/neurintsurg-2021-018632","volume":"14","author":"R de Leacy","year":"2022","unstructured":"de Leacy R, Ansari SA, Schirmer CM, Cooke DL, Prestigiacomo CJ, Bulsara KR, Hetts SW. Endovascular treatment in the multimodality management of brain arteriovenous malformations: report of the Society of NeuroInterventional Surgery Standards and Guidelines Committee. J\u00a0NeuroIntervent Surg. 2022;14:1118\u201324. https:\/\/doi.org\/10.1136\/neurintsurg-2021-018632.","journal-title":"J NeuroIntervent Surg"},{"key":"1502_CR2","doi-asserted-by":"publisher","first-page":"1111","DOI":"10.1136\/jnis-2022-019859","volume":"15","author":"DF Vollherbst","year":"2023","unstructured":"Vollherbst DF, Boppel T, Wallocha M, Berlis A, Maurer CJ, Weber W, et al. LIQUID\u2014Treatment of high-grade dural arteriovenous fistulas with Squid liquid embolic agent: a\u00a0prospective, observational multicenter study. J\u00a0NeuroIntervent Surg. 2023;15:1111\u20136. https:\/\/doi.org\/10.1136\/jnis-2022-019859.","journal-title":"J NeuroIntervent Surg"},{"key":"1502_CR3","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1007\/s00062-024-01425-z","volume":"34","author":"J Fiehler","year":"2024","unstructured":"Fiehler J, Bechstein M. Does Every Subdural Hematoma Patient Need an Embolization? Clin Neuroradiol. 2024;34:289\u201391. https:\/\/doi.org\/10.1007\/s00062-024-01425-z.","journal-title":"Clin Neuroradiol"},{"key":"1502_CR4","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1007\/s00062-021-01066-6","volume":"32","author":"DF Vollherbst","year":"2022","unstructured":"Vollherbst DF, Chapot R, Bendszus M, M\u00f6hlenbruch MA. Glue, Onyx, Squid or PHIL? Liquid Embolic Agents for the Embolization of Cerebral Arteriovenous Malformations and Dural Arteriovenous Fistulas. Clin Neuroradiol. 2022;32:25\u201338. https:\/\/doi.org\/10.1007\/s00062-021-01066-6.","journal-title":"Clin Neuroradiol"},{"key":"1502_CR5","doi-asserted-by":"publisher","first-page":"126","DOI":"10.3174\/ajnr.A6867","volume":"42","author":"N Schmitt","year":"2021","unstructured":"Schmitt N, Floca RO, Paech D, El Shafie RA, Seker F, Bendszus M, et al. Imaging Artifacts of Liquid Embolic Agents on Conventional CT in an Experimental in Vitro Model. Ajnr Am J Neuroradiol. 2021;42:126\u201331. https:\/\/doi.org\/10.3174\/ajnr.A6867.","journal-title":"Ajnr Am J Neuroradiol"},{"key":"1502_CR6","doi-asserted-by":"publisher","first-page":"637","DOI":"10.1148\/radiol.2015142631","volume":"276","author":"CH McCollough","year":"2015","unstructured":"McCollough CH, Leng S, Yu L, Fletcher JG. Dual- and Multi-Energy CT: Principles, Technical Approaches, and Clinical Applications. Radiology. 2015;276:637\u201353. https:\/\/doi.org\/10.1148\/radiol.2015142631.","journal-title":"Radiology"},{"key":"1502_CR7","doi-asserted-by":"publisher","first-page":"183","DOI":"10.3174\/ajnr.A8093","volume":"45","author":"F Risch","year":"2024","unstructured":"Risch F, Berlis A, Kroencke T, Schwarz F, Maurer CJ. Discrimination of Hemorrhage and Contrast Media in a\u00a0Head Phantom on Photon-Counting Detector CT Data. AJNR Am J Neuroradiol. 2024;45:183\u20137. https:\/\/doi.org\/10.3174\/ajnr.A8093.","journal-title":"AJNR Am J Neuroradiol"},{"key":"1502_CR8","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1016\/j.diii.2022.11.003","volume":"104","author":"J Greffier","year":"2023","unstructured":"Greffier J, Villani N, Defez D, Dabli D, Si-Mohamed S. Spectral CT imaging: Technical principles of dual-energy CT and multi-energy photon-counting CT. Diagn Interv Imaging. 2023;104:167\u201377. https:\/\/doi.org\/10.1016\/j.diii.2022.11.003.","journal-title":"Diagn Interv Imaging"},{"key":"1502_CR9","doi-asserted-by":"publisher","first-page":"8949","DOI":"10.1088\/0031-9155\/60\/23\/8949","volume":"60","author":"H Atak","year":"2015","unstructured":"Atak H, Shikhaliev PM. Dual energy CT with photon counting and dual source systems: comparative evaluation. Phys Med Biol. 2015;60:8949\u201375. https:\/\/doi.org\/10.1088\/0031-9155\/60\/23\/8949.","journal-title":"Phys Med Biol"},{"key":"1502_CR10","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics12061467","volume-title":"Assessment of Iodine Contrast-To-Noise Ratio in Virtual Monoenergetic Images Reconstructed from Dual-Source","author":"R Booij","year":"2022","unstructured":"Booij R, van der Werf NR, Dijkshoorn ML, van der Lugt A, van Straten M. Assessment of Iodine Contrast-To-Noise Ratio in Virtual Monoenergetic Images Reconstructed from Dual-Source. Integrating CT and Photon-Counting CT Data. Diagnostics (Basel): Energy; 2022. https:\/\/doi.org\/10.3390\/diagnostics12061467."},{"key":"1502_CR11","doi-asserted-by":"publisher","first-page":"4679","DOI":"10.1088\/0031-9155\/52\/15\/020","volume":"52","author":"E Roessl","year":"2007","unstructured":"Roessl E, Proksa R. K-edge imaging in x-ray computed tomography using multi-bin photon counting detectors. Phys Med Biol. 2007;52:4679\u201396. https:\/\/doi.org\/10.1088\/0031-9155\/52\/15\/020.","journal-title":"Phys Med Biol"},{"key":"1502_CR12","doi-asserted-by":"publisher","first-page":"158","DOI":"10.1016\/j.clinimag.2021.04.020","volume":"79","author":"I Riederer","year":"2021","unstructured":"Riederer I, Fingerle AA, Zimmer C, No\u00ebl PB, Makowski MR, Pfeiffer D. Potential of dual-layer spectral CT for the differentiation between hemorrhage and iodinated contrast medium in the brain after endovascular treatment of ischemic stroke patients. Clin Imaging. 2021;79:158\u201364. https:\/\/doi.org\/10.1016\/j.clinimag.2021.04.020.","journal-title":"Clin Imaging"},{"key":"1502_CR13","doi-asserted-by":"publisher","first-page":"20220544","DOI":"10.1259\/bjr.20220544","volume":"96","author":"T Sartoretti","year":"2023","unstructured":"Sartoretti T, Wildberger JE, Flohr T, Alkadhi H. Photon-counting detector CT: early clinical experience review. Br J Radiol. 2023;96:20220544. https:\/\/doi.org\/10.1259\/bjr.20220544.","journal-title":"Br J Radiol"},{"key":"1502_CR14","doi-asserted-by":"publisher","first-page":"121634","DOI":"10.1016\/j.biomaterials.2022.121634","volume":"287","author":"G Ko","year":"2022","unstructured":"Ko G, Choi JW, Lee N, Kim D, Hyeon T, Kim H-C. Recent progress in liquid embolic agents. Biomaterials. 2022;287:121634. https:\/\/doi.org\/10.1016\/j.biomaterials.2022.121634.","journal-title":"Biomaterials"},{"key":"1502_CR15","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1016\/j.neurad.2023.01.048","volume":"50","author":"R Coudert","year":"2023","unstructured":"Coudert R. Reduction of tantalum artifacts with spectral CT scan for the analysis of brain avm after embolization. J\u00a0Neuroradiol. 2023;50:131\u20132. https:\/\/doi.org\/10.1016\/j.neurad.2023.01.048.","journal-title":"J Neuroradiol"},{"key":"1502_CR16","doi-asserted-by":"publisher","DOI":"10.1136\/jnis-2023-021442","author":"JC Llibre-Guerra","year":"2024","unstructured":"Llibre-Guerra JC, Guimaraens L, Kadziolka KB, Siddiqui AH, Chapot R, Gil A. ihtObtura: A\u00a0novel liquid embolic agent with post-embolization radiopacity loss. J\u00a0NeuroIntervent Surg. 2024; https:\/\/doi.org\/10.1136\/jnis-2023-021442.","journal-title":"J NeuroIntervent Surg"},{"key":"1502_CR17","doi-asserted-by":"publisher","first-page":"515","DOI":"10.1097\/RLI.0000000000000978","volume":"58","author":"G Jost","year":"2023","unstructured":"Jost G, McDermott M, Gutjahr R, Nowak T, Schmidt B, Pietsch H. New Contrast Media for K-Edge Imaging With Photon-Counting Detector CT. Invest Radiol. 2023;58:515\u201322. https:\/\/doi.org\/10.1097\/RLI.0000000000000978.","journal-title":"Invest Radiol"},{"key":"1502_CR18","doi-asserted-by":"publisher","first-page":"273","DOI":"10.1016\/j.joca.2023.01.278","volume":"31","author":"P Paakkari","year":"2023","unstructured":"Paakkari P, Inkinen SI, J\u00e4ntti J, Tuppurainen J, Fugazzola MC, Joenathan A, et al. Tantalum And Iodine Based Dual-Contrast Photon-Counting Computed Tomography Method For Assessment Of Articular Cartilage Composition. Osteoarthr Cartil. 2023;31:273. https:\/\/doi.org\/10.1016\/j.joca.2023.01.278.","journal-title":"Osteoarthr Cartil"},{"key":"1502_CR19","doi-asserted-by":"publisher","first-page":"507","DOI":"10.1007\/s00117-023-01135-6","volume":"63","author":"S Sawall","year":"2023","unstructured":"Sawall S. Neue Kontrastmittel f\u00fcr die photonenz\u00e4hlende Computertomographie. Radiologie. 2023;63:507\u201312. https:\/\/doi.org\/10.1007\/s00117-023-01135-6.","journal-title":"Radiologie"},{"key":"1502_CR20","doi-asserted-by":"publisher","first-page":"594","DOI":"10.1136\/neurintsurg-2022-018958","volume":"15","author":"N Schmitt","year":"2023","unstructured":"Schmitt N, Wucherpfennig L, Hohenstatt S, Weyland CS, Sommer CM, Bendszus M, et al. Visibility of liquid embolic agents in fluoroscopy: a\u00a0systematic in vitro study. J\u00a0NeuroIntervent Surg. 2023;15:594\u20139. https:\/\/doi.org\/10.1136\/neurintsurg-2022-018958.","journal-title":"J NeuroIntervent Surg"},{"key":"1502_CR21","doi-asserted-by":"publisher","first-page":"70","DOI":"10.5334\/jbsr.2083","volume":"104","author":"Y Zaouak","year":"2020","unstructured":"Zaouak Y, Sadeghi N, Sarbu N, Ligot N, Lubicz B. Differentiation between Cerebral Hemorrhage and Contrast Extravasation Using Dual Energy Computed Tomography after Intra-Arterial Neuro Interventional. Procedures J Belg Soc Radiol. 2020;104:70. https:\/\/doi.org\/10.5334\/jbsr.2083.","journal-title":"Procedures J Belg Soc Radiol"},{"key":"1502_CR22","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1007\/s00062-022-01198-3","volume":"33","author":"R Grkovski","year":"2023","unstructured":"Grkovski R, Acu L, Ahmadli U, Terziev R, Schubert T, Wegener S, et al. Stroke. 2023;33:171\u20137. https:\/\/doi.org\/10.1007\/s00062-022-01198-3.","journal-title":"Stroke"},{"key":"1502_CR23","doi-asserted-by":"publisher","first-page":"978","DOI":"10.3174\/ajnr.A3906","volume":"35","author":"H Baharvahdat","year":"2014","unstructured":"Baharvahdat H, Blanc R, Termechi R, Pistocchi S, Bartolini B, Redjem H, Piotin M. Hemorrhagic complications after endovascular treatment of cerebral arteriovenous malformations. AJNR Am J Neuroradiol. 2014;35:978\u201383. https:\/\/doi.org\/10.3174\/ajnr.A3906.","journal-title":"AJNR Am J Neuroradiol"},{"key":"1502_CR24","doi-asserted-by":"publisher","first-page":"442","DOI":"10.1097\/RLI.0000000000001036","volume":"59","author":"S Skornitzke","year":"2024","unstructured":"Skornitzke S, Mergen V, Biederer J, Alkadhi H, Do TD, Stiller W, et al. Metal Artifact Reduction in Photon-Counting Detector CT. Invest Radiol. 2024;59:442\u20139. https:\/\/doi.org\/10.1097\/RLI.0000000000001036.","journal-title":"Invest Radiol"},{"key":"1502_CR25","doi-asserted-by":"publisher","first-page":"803","DOI":"10.1007\/s00330-022-09073-y","volume":"33","author":"N Schmitt","year":"2023","unstructured":"Schmitt N, Wucherpfennig L, Rotkopf LT, Sawall S, Kauczor H-U, Bendszus M, et al. Metal artifacts and artifact reduction of neurovascular coils in photon-counting detector CT versus energy-integrating detector CT\u2014in vitro comparison of a\u00a0standard brain imaging protocol. Eur Radiol. 2023;33:803\u201311. https:\/\/doi.org\/10.1007\/s00330-022-09073-y.","journal-title":"Eur Radiol"}],"container-title":["Clinical Neuroradiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00062-025-01502-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00062-025-01502-x\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00062-025-01502-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,24]],"date-time":"2025-09-24T13:07:12Z","timestamp":1758719232000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00062-025-01502-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,6]]},"references-count":25,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2025,9]]}},"alternative-id":["1502"],"URL":"https:\/\/doi.org\/10.1007\/s00062-025-01502-x","relation":{},"ISSN":["1869-1439","1869-1447"],"issn-type":[{"value":"1869-1439","type":"print"},{"value":"1869-1447","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,6]]},"assertion":[{"value":"29 October 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 January 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 February 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"A.\u00a0Berlis received consulting fees and honoraria as a\u00a0proctor for MicroVention and consults as a\u00a0proctor for Stryker Neurovascular and Medtronic. C.J.\u00a0Maurer, F.J.\u00a0Stangl and L.\u00a0Behrens declarethat they have no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"This is a\u00a0single-center retrospective observational study. The study was approved by the Institutional Review Board of the Ludwig-Maximilian-University of Munich. The study was conducted in accordance with the ethical standards of the Declaration of Helsinki of 1964 and its subsequent amendments. Due to the retrospective design and the irreversible anonymization of patient data, the requirement for individual informed consent was waived.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical standards"}}]}}