Department of Neurosurgery, St Michael's Hospital, Toronto, Ontario, Canada
RADIS lab, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada.
J Neurointerv Surg. 2023 Nov;15(e2):e223-e228. doi: 10.1136/jnis-2021-018201. Epub 2022 Dec 23.
Imaging assessment for acute ischemic stroke (AIS) patients in the angiosuite using cone beam CT (CBCT) has created increased interest since endovascular treatment became the first line therapy for proximal vessel occlusions. One of the main challenges of CBCT imaging in AIS patients is degraded image quality due to motion artifacts. This study aims to evaluate the prevalence of motion artifacts in CBCT stroke imaging and the effectiveness of a novel motion artifact correction algorithm for image quality improvement.
Patients presenting with acute stroke symptoms and considered for endovascular treatment were included in the study. CBCT scans were performed using the angiosuite X-ray system. All CBCT scans were post-processed using a motion artifact correction algorithm. Motion artifacts were scored before and after processing using a 4-point scale.
We prospectively included 310 CBCT scans from acute stroke patients. 51% (n=159/310) of scans had motion artifacts, with 24% being moderate to severe. The post-processing algorithm improved motion artifacts in 91% of scans with motion (n=144/159), restoring clinical diagnostic capability in 34%. Overall, 76% of the scans were sufficient for clinical decision-making before correction, which improved to 93% (n=289/310) after post-processing with our algorithm.
Our results demonstrate that CBCT motion artifacts are significantly reduced using a novel post-processing algorithm, which improved brain CBCT image quality and diagnostic assessment for stroke. This is an important step on the road towards a direct-to-angio approach for endovascular thrombectomy (EVT) treatment.
血管内治疗成为近端血管闭塞的一线治疗方法后，锥形束 CT（CBCT）在血管套房中对急性缺血性脑卒中（AIS）患者的影像学评估引起了越来越多的关注。AIS 患者 CBCT 成像的主要挑战之一是由于运动伪影导致的图像质量下降。本研究旨在评估 CBCT 脑卒中成像中运动伪影的发生率，以及一种新的运动伪影校正算法对图像质量改善的效果。
本研究纳入了有急性脑卒中症状并考虑血管内治疗的患者。使用血管套房 X 射线系统进行 CBCT 扫描。所有 CBCT 扫描均使用运动伪影校正算法进行后处理。使用 4 分制对处理前后的运动伪影进行评分。
我们前瞻性纳入了 310 例急性脑卒中患者的 CBCT 扫描。51%（n=159/310）的扫描存在运动伪影，其中 24%为中重度。后处理算法改善了 91%（n=144/159）有运动的扫描中的运动伪影，使 34%的扫描恢复了临床诊断能力。总体而言，在进行校正之前，76%的扫描足以进行临床决策，而使用我们的算法进行后处理后，这一比例提高到了 93%（n=289/310）。
我们的结果表明，使用新的后处理算法可以显著减少 CBCT 运动伪影，从而改善脑 CBCT 图像质量和脑卒中的诊断评估。这是直接进行血管内取栓术（EVT）治疗的重要一步。
