PT  - JOURNAL ARTICLE
AU  - Nicole Mariantonia Cancelliere
AU  - Eric Hummel
AU  - Fred van Nijnatten
AU  - Peter van de Haar
AU  - Paul Withagen
AU  - Marijke van Vlimmeren
AU  - Bertan Hallacoglu
AU  - Ronit Agid
AU  - Patrick Nicholson
AU  - Vitor Mendes Pereira
TI  - The butterfly effect: improving brain cone-beam CT image artifacts for stroke assessment using a novel dual-axis trajectory
AID  - 10.1136/neurintsurg-2021-018553
DP  - 2022 Apr 26
TA  - Journal of NeuroInterventional Surgery
PG  - neurintsurg-2021-018553
4099  - http://jnis.bmj.com/content/early/2022/04/26/neurintsurg-2021-018553.short
4100  - http://jnis.bmj.com/content/early/2022/04/26/neurintsurg-2021-018553.full
AB  - Background 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.Objective To perform a detailed evaluation of image artifact improvement using a new CBCT protocol which implements a novel dual-axis ‘butterfly’ trajectory.Methods 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.Results 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).Conclusions 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.All data relevant to the study are included in the article or uploaded as supplementary information. Not applicable.