Background Cone-beam computed tomography (CBCT) facilitates the acquisition of cross-sectional imaging in angiography suites using a rotational C-arm and digital flat panel detectors. The applications are numerous, including evaluation of implanted devices and localization of cerebrovascular lesions. We present and validate the clinical utility of an alternative fast CBCT acquisition protocol in the context of neurovascular device imaging.
Methods Contrast-enhanced (CE)-CBCT images were acquired using a new 10 s protocol in a phantom head model, swine model, and in patients. The acquisition parameters of both the 10 s and 20 s protocols were exactly the same, except for fewer projections (250 projections in 10 s vs 500 projections in 20 s), resulting in reduced scan time. Image quality was measured quantitatively in a controlled phantom study and qualitatively by blinded reviewers. The latter was performed to assess the image quality of the 10 s protocol pertinent to the device visibility and its apposition to the parent artery.
Results 10 s CBCT images were comparable to 20 s CBCT in both phantom and animal studies. Of the 25 patient images, the reviewers agreed that they were able to discern the flow diverter struts and assess the apposition in all images. The overall rating for all 10 s images was 4.28 on a 5-point scale. No images were rated as less than 3, which was the average diagnostic quality. The ratings were concordant across three blinded reviewers (κ=0.411). Additionally, contrast and spatial resolution between 10 s and 20 s images were similar in non-human models.
Conclusions CBCT images of neurovascular devices can be obtained successfully using a 10 s acquisition protocol. In addition, the 10 s protocol offers faster acquisition, thus allowing its use in awake patients and with an added advantage of lower radiation and contrast dose.
- flow diverter
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Contributors Conception and design: PK, VMS, SRC, GC. Acquisition of data: all authors. Analysis and Interpretation of data: PK, VMS, SRC, GC, KMC. Drafting the article: PK, VMS, SRC, GC. Critically revising the article: all authors. Reviewed submitted version of manuscript: PK, VMS, KMC, GC, JJ, SRC. Study supervision: PK, SRC.
Disclaimer Dr PK serves as a consultant to Stryker and Medtronic.
Competing interests GC is an employee of Siemens Healthcare USA, the manufacturer and developer of the angiographic equipment and software used in this work.
Ethics approval Baylor College of Medicine Institution Review Board (IRB)
Provenance and peer review Not commissioned; externally peer reviewed.