Background 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.
Methods 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.
Results 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.
Conclusions 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.
Data availability statement
All data relevant to the study are included in the article or uploaded as supplementary information.
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Contributors All authors substantially contributed to the manuscript. VMP and NMC designed the work; NMC and VMP drafted the original manuscript; and all authors were involved in data acquisition, interpretation of data for the work, critical revision for important intellectual content, final approval of the version to be published, and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work were appropriately investigated and resolved. VMP is the guarantor of the study.
Funding This research was supported by a Master Research Agreement between Philips and Toronto Western Hospital.
Competing interests FvN, PvdH, EH, MvV, PW and BH are employed by Philips. This research was supported by a Master Research Agreement between Philips and Toronto Western Hospital.
Provenance and peer review Not commissioned; externally peer reviewed.
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