Appropriate iMAR presets for metal artifact reduction from surgical clips and titanium burr hole covers on postoperative non-contrast brain CT

•iMAR neuro-coils preset most effectively reduced metal artifacts from clips on NCCT.•iMAR neuro-coils preset increased metal artifacts from burr hole covers (BHCs) on NCCT.•iMAR shoulder implants preset reduced artifacts from both clips and BHCs on NCCT. To evaluate suitable iterative metal artifact reduction (iMAR) presets for titanium neurosurgical clips and burr hole covers (BHCs) on postoperative non-contrast computed tomography (NCCT). Twenty-two patients who underwent NCCT after intracranial aneurysmal clipping were included. NCCT images were postprocessed using eight currently available iMAR presets. In each image, a circular region of interest (ROI) was placed around clip, BHC, and on parietal lobe as reference. Standard deviation (SD) and attenuation value (HU) were measured in each ROI to obtain artifact index (AI) and contrast-to-noise ratio (CNR). For each iMAR preset, SD, AI, HU, and CNR were compared with those without iMAR for clips and BHCs. Visual assessment around each clip and BHC was performed by two neuroradiologists using three-point visual score (VS) (1 = no apparent, 2 = minor, and 3 = severe artifacts). Among the presets, the neuro-coils preset (iMAR-NC) showed the lowest SD, AI, and VS for clips (P < 0.001). For BHCs, HU, CNR, and VS with iMAR-NC were significantly higher than those without iMAR (P < 0.001). SD, AI, and VS with the shoulder implants preset (iMAR-ShI) were significantly lower than those without iMAR for clips (P = 0.002, 0.002, and P