Motion artifact correction for cone beam CT stroke imaging: a prospective series

Area of Science:

• Medical Imaging
• Neurology
• Radiology

Background:

• Cone beam CT (CBCT) is increasingly used for acute ischemic stroke (AIS) imaging in angiosuites, especially with endovascular treatment as first-line therapy.
• Motion artifacts significantly degrade CBCT image quality in AIS patients, posing a challenge for accurate diagnosis and treatment planning.
• Evaluating the prevalence of motion artifacts and the efficacy of correction algorithms is crucial for optimizing CBCT in stroke care.

Purpose of the Study:

• To determine the prevalence of motion artifacts in CBCT scans of acute ischemic stroke patients.
• To assess the effectiveness of a novel post-processing algorithm in correcting motion artifacts and improving image quality.
• To evaluate the impact of motion artifact correction on the diagnostic capability of CBCT for stroke assessment.

Main Methods:

• Prospective inclusion of 310 CBCT scans from patients with acute stroke symptoms undergoing consideration for endovascular treatment.
• CBCT scans were acquired using an angiosuite X-ray system.
• A novel motion artifact correction algorithm was applied as post-processing; artifacts were scored pre- and post-correction on a 4-point scale.

Main Results:

• Motion artifacts were present in 51% of scans (n=159/310), with 24% classified as moderate to severe.
• The correction algorithm improved motion artifacts in 91% of affected scans (n=144/159), restoring diagnostic capability in 34%.
• The proportion of scans sufficient for clinical decision-making increased from 76% to 93% (n=289/310) after post-processing.

Conclusions:

• A novel post-processing algorithm effectively reduces CBCT motion artifacts in acute ischemic stroke patients.
• The algorithm significantly enhances brain CBCT image quality and improves diagnostic assessment for stroke.
• This advancement supports the development of direct-to-angio approaches for endovascular thrombectomy (EVT).