Follow-up imaging after massive Coil & Onyx embolization: How do you deal with artifacts?

General
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Hi everyone,

I hope you are all doing well. It’s been a while since my last update. I’m a 31-year-old guy dealing with a voluminous, high-flow pelvic AVM. Recently, I went through two more interventions, culminating in a massive transvenous embolization where my doctors densely packed the AVM with a huge amount of platinum coils and 4 ml of Onyx.

The great news is that I am currently asymptomatic and recovering well!

However, my medical team and I are now facing a new diagnostic challenge for my follow-ups. They want to monitor the AVM to ensure it stays stable and check for any recurrence, but they really want to avoid invasive catheter angiograms just for routine surveillance.

The problem is the artifacts. Because of the massive density of the metal coils and the Onyx, standard CT scans and MRIs are basically unreadable in that specific area (massive streaks, beam-hardening, and magnetic signal voids).

I am wondering if anyone here—whether your AVM is in the brain, spine, extremities, or pelvis—has been in a similar situation with a massive amount of hardware and glue.

  • Have your doctors successfully used any advanced, non-invasive imaging to monitor your AVM clearly?

  • Has anyone had success with specialized scans like Dual-Energy CT (DECT), Photon-Counting CT, or special artifact-reducing MRI sequences (like SEMAC or MAVRIC)?

  • Did they manage to bypass the metal artifacts, or did you find that an invasive angiogram is ultimately the only way to get a clear picture?

I would love to hear your experiences and learn how your doctors handle your routine check-ups when the AVM is heavily packed with coils and Onyx.

Thank you all so much, and wishing you all the best!

1 Like
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@PelvicAndUterine @Extremity has anyone any experience of these things?

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Hi! I’m currently recovering from my second pelvic embolization and I will be having CT scan and MRI in August to check for residual flow.

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Hi @jamz

It’s good to hear from you. Does your existing embolization have just glue in it or does it have coils or other embolic material in apart from glue/Onyx?

Richard

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Loads of coils and onyx!! I can’t even count how much there is, I have a list of them all and it’s about 4 pages long. He said the CT scan would maybe struggle to show up any leaks behind it all so I’d need an MRI.

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I think the mass was about 4cm but there were lots and lots of feeder veins. My ops were about 6 and 5 hours but they are happy they have got everything now.

What has your journey been like @infidel94

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Hi,

Thank you so much for taking the time to reply!

Our stories are incredibly similar. Two interventions of 5 Hours each. My AVM is also located deep in the pelvis, and just like you, my recent interventions left me with a massive, dense block of platinum coils and Onyx glue. Hearing that your specialized hospital has successfully found a way to “look past” all that hardware without doing an invasive angiogram gives me so much hope!

Just out of curiosity, since our operations were so alike, were you put under general anesthesia during your procedures in the operating room?

If you have the time, would it be possible for you to reach out to your surgeons or medical team (via email or a quick chat) to ask them a couple of quick questions about the August diagnostic?

Specifically, it would be a game-changer if you could find out the exact technical name of the MRI or CT scan they perform. Even if they tell you the name in your native language, it would be extremely helpful. I am trying to find out if they use a specific metal artifact reduction algorithm (like SEMAC or MAVRIC for MRI, or specific CT equivalents), a special MRI sequence / CT protocol, or if they combine it with other exams like Duplex sonography.

Also, it would be great to know if your doctors are currently just “testing” these scans to see if they can get a clear picture, or if they already have solid experience with this method and consider it their proven “gold standard” for monitoring patients with massive coils and Onyx.

The reason I’m asking—and why this would be of immense help to me—is that I am due for a follow-up check this September, but my medical team hasn’t been able to officially schedule it yet because they literally do not know which non-invasive exam to prescribe me. My interventional radiologist seems to be facing this specific follow-up scenario for the first time; he really wants to avoid an unnecessary invasive angiogram, but he doesn’t know which specific MRI or CT protocol could work better to bypass the artifacts.

Any exact technical details or insights you can get from your specialized center would truly be a lifesaver for me.

Thank you again for your kindness and for even considering helping me with this! Wishing you continued health and a great recovery.

Best regards,

Adriano