Departments of Neurosurgery and Medical Imaging, St Michael's Hospital, Toronto, Ontario, Canada
Keenan Research Centre, Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada.
J Neurointerv Surg. 2023 Mar;15(3):283-287. doi: 10.1136/neurintsurg-2021-018553. Epub 2022 Apr 27.
Cone-beam computed tomography (CBCT) imaging of the brain can be performed in the angiography suite to support various neurovascular procedures. Relying on CBCT brain imaging solely, however, still lacks full diagnostic confidence due to the inferior image quality compared with CT and various imaging artifacts that persist even with modern CBCT.
To perform a detailed evaluation of image artifact improvement using a new CBCT protocol which implements a novel dual-axis 'butterfly' trajectory.
Our study included 94 scans from 47 patients who received CBCT imaging for assessment of either ischemia or hemorrhage during a neurovascular procedure. Both a traditional uni-axis 'circular' and novel dual-axis 'butterfly' protocol were performed on each patient (same-patient control). Each brain scan was divided into six regions and scored out of 3 based on six artifacts originating from various physics-based and patient-based sources.
The dual-axis trajectory produces CBCT images with significantly fewer image artifacts than the traditional circular scan (whole brain average artifact score, AS: 0.20 vs 0.33), with the greatest improvement in bone beam hardening (AS: 0.13 vs 0.78) and cone-beam artifacts (AS: 0.04 vs 0.55).
Recent developments in CBCT imaging protocols have significantly improved image artifacts, which has improved diagnostic confidence for stroke and supports a direct-to-angiography suite transfer approach for patients with acute ischemic stroke.
脑部锥形束 CT（CBCT）成像可在血管造影套件中进行，以支持各种神经血管程序。然而，仅依靠 CBCT 脑部成像，由于与 CT 相比图像质量较差，以及即使使用现代 CBCT 仍存在各种成像伪影，因此仍然缺乏充分的诊断信心。
使用新的 CBCT 协议来详细评估图像伪影的改善情况，该协议采用了新的双轴“蝴蝶”轨迹。
我们的研究包括 47 名患者的 94 次扫描，这些患者在神经血管程序中接受 CBCT 成像以评估缺血或出血。在每个患者身上（同患者对照）都进行了传统的单轴“圆形”和新的双轴“蝴蝶”协议。每个脑部扫描分为六个区域，并根据六个源自各种物理和患者来源的伪影对每个区域进行 3 分制评分。
双轴轨迹产生的 CBCT 图像的伪影明显少于传统的圆形扫描（全脑平均伪影评分，AS：0.20 比 0.33），其中骨束硬化（AS：0.13 比 0.78）和锥形束伪影（AS：0.04 比 0.55）的改善最大。
CBCT 成像协议的最新发展显著改善了图像伪影，从而提高了对中风的诊断信心，并支持将急性缺血性中风患者直接转移到血管造影套件。
