{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T16:04:06Z","timestamp":1790179446905,"version":"4.1.0"},"reference-count":25,"publisher":"BMJ","issue":"8","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J NeuroIntervent Surg"],"accepted":{"date-parts":[[2014,6,6]]},"published-print":{"date-parts":[[2015,8]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Dual-energy CT (DECT) has been shown to be a useful modality in neuroradiology.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To assess failure modes and limitations of DECT in different neuroimaging applications.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Patients and methods<\/jats:title>\n                  <jats:p>Dual-source DECT scans were performed in 72 patients over 30\u2005months to differentiate contrast agent staining or extravasation from intracranial hemorrhage (ICH) (n=40); to differentiate calcium from ICH (n=2); for metal-artifact reduction (n=5); and for angiographic assessment (n=25). A three-material decomposition algorithm was used to obtain virtual non-contrast (VNC) and iodine (or calcium) overlay images. Images were analyzed in consensus by two board-certified radiologists to determine the success of the algorithm and to assess confounding factors. Furthermore, a dilution experiment using cylinders containing defined heparinized swine blood, normal saline, and selected iodine concentrations was conducted to assess other possible confounding factors.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Dual-energy analysis was successful in 65 (90.2%) patients. However, the algorithm failed when images were affected by beam hardening (n=3, 4.2%), the presence of a fourth material (parenchymal calcification) (n=3, 4.2%), or motion (n=1, 1.4%). In the dilution experiment, a saturation effect was seen at high iodine concentrations (\u226537\u2005mg\/ml). VNC and iodine overlay images were not reliable above this concentration, and beam-hardening artifacts were noted.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>DECT material decomposition is usually successful in neuroradiology. However, it can only distinguish up to three preselected materials. A fourth material such as parenchymal calcium may confound the analysis. Artifacts such as beam hardening, metallic streak, or saturation effect can also impair material decomposition.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/neurintsurg-2014-011241","type":"journal-article","created":{"date-parts":[[2014,6,21]],"date-time":"2014-06-21T03:36:07Z","timestamp":1403321767000},"page":"596-602","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":38,"title":["Technical limitations of dual-energy CT in neuroradiology: 30-month institutional experience and review of literature"],"prefix":"10.1136","volume":"7","author":[{"given":"Julien","family":"Dinkel","sequence":"first","affiliation":[{"name":"Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA"},{"name":"Department of Radiology, University Hospital Heidelberg, Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omid","family":"Khalilzadeh","sequence":"additional","affiliation":[{"name":"Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine M","family":"Phan","sequence":"additional","affiliation":[{"name":"Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ajit H","family":"Goenka","sequence":"additional","affiliation":[{"name":"Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Albert J","family":"Yoo","sequence":"additional","affiliation":[{"name":"Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, 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