Objective: To evaluate the application value of combining spectral imaging and metal artifact reduction (MAR) in head and neck CTA after the embolization of intracranial aneurysms. Methods: We collected 37 patients who experienced embolization of intracranial aneurysms then received spectral imaging of head and neck CTA. Monochromatic images with energy ranging from 70～140 keV, 120 kVp-like mixed energic images, 70～140 keV MAR images, and 120 kVp-like MAR images were generated. The region of interest was placed on the area near the coil and with the most serious metal artifact. CT attenuation and standard deviation were measured, and artifact index (AI) and signal-noise ratio (SNR) were calculated. Two radiologists independently subjectively evaluated the metal artifact and the display of surrounding vessels using Likert 5 scales. The subjective scores and objective parameters between MAR and non-MAR images were compared. The Wilcoxon ranking test, paired sample t test, and independent sample t
test were utilized to compare parameters between the groups. Results: MAR images had significantly lower AI than did non-MAR images for all eight monochromatic energies. When energies ranged from 80~110 keV, SNR was higher for MAR images than for non-MAR images, and the difference was statistically significant. With same energies, MAR images had higher artifact and vessel display scores than did non-MAR images. For non-MAR images, the different coil diameters did not make a statistical difference in AI and vessel display scores. For MAR images, a larger coil diameter (>8.79 mm) led to higher AI and lower vessel display scores than did normal diameters (≤8.79 mm). Conclusion: The combination of spectral imaging and MAR could effectively reduce the metal artifact of implants for the embolization of intracranial aneurysms and improve the surrounding vessel display. Moreover, the metal artifact reduction effect was more significant for the coils with smaller diameters.