Clinical evaluation of dual-energy bone removal in CT angiography of the head and neck: comparison with conventional bone-subtraction CT angiography

Clin Radiol. 2009 May;64(5):534-41. doi: 10.1016/j.crad.2009.01.007. Epub 2009 Mar 17.


Aim: To evaluate the bone-subtraction effect of dual-energy bone removal in computed tomography angiography (CTA) of the head and neck in comparison with conventional bone-subtraction CTA.

Material and methods: The study comprised 52 patients who were divided into two groups at random, and examined using dual-source CT for head and neck CTA. Dual-energy bone removal CTA and conventional bone-subtraction CTA were applied to each of the two groups, respectively. The bone subtraction was performed automatically in both methods. Vascular structures, as well as brain tissue remained visible. The subtracted images were further processed with maximum intensity projection (MIP) and volume-rendering technique (VRT) for image evaluation. Two experienced radiologists reviewed the resulting subtracted and non-subtracted volume data with respect to the delineation and detection of image quality and vascular pathology.

Results: The means of the weighted CT dose index (CTDIvol) for bone-removal dual-energy CTA and conventional bone-subtraction CTA were 20.56+/-0.01 mGy and 25.57+/-0.56 mGy, respectively. There was a significant difference between them. The percentage of carotid and vertebral arteries and all other vessels that could be successfully assessed with these two methods were 87.8, 68, and 83%, and 93.5, 91.8, and 92.6%, respectively. There were no significant differences in the visualization of the carotid arteries; however, there were significant differences in the visualization of the vertebral arteries.

Conclusion: Compared with conventional bone-subtraction CTA, dual-energy bone-removal CTA had a lower radiation dose. It eliminated most bones in the head and neck successfully; however, the bone subtraction effect around the vertebral artery was unsatisfactory. Dual-energy bone-removal CTA provides a new method for detecting vascular diseases in routine clinical work.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Absorptiometry, Photon
  • Adolescent
  • Adult
  • Aged
  • Angiography, Digital Subtraction / methods*
  • Bone and Bones / diagnostic imaging
  • Carotid Arteries / diagnostic imaging
  • Contrast Media
  • Female
  • Head / diagnostic imaging*
  • Humans
  • Image Processing, Computer-Assisted / methods
  • Male
  • Middle Aged
  • Neck / diagnostic imaging*
  • Radiation Dosage
  • Radiographic Image Interpretation, Computer-Assisted / methods
  • Tomography, X-Ray Computed / methods*
  • Vascular Diseases / diagnostic imaging
  • Vertebral Artery / diagnostic imaging
  • Young Adult


  • Contrast Media