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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 28:1362-1368, August 2007
DOI 10.3174/ajnr.A0558
© 2007 American Society of Neuroradiology

HEAD & NECK

Bone-Subtraction CT Angiography: Evaluation of Two Different Fully Automated Image-Registration Procedures for Interscan Motion Compensation

M.M. Lell^a, H. Ditt^b, C. Panknin^a,b, J.W. Sayre^a,c, S.G. Ruehm^a, E. Klotz^b, B.F. Tomandl^d and J.P. Villablanca^a

^a Department of Radiological Sciences, David Geffen School of Medicine at the University of California, Los Angeles, Calif
^b Siemens Medical Solutions, Forchheim, Germany
^c Department of Biostatistics, the University of California, Los Angeles School of Public Health, Los Angeles, Calif
^d Department of Neuroradiology, Klinikum Bremen-Mitte, Bremen, Germany

Please address correspondence to Michael Lell, MD, Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Peter V. Ueberroth Bldg, Suite 3371, 10945 LeConte Ave, Los Angeles, CA 90095; e-mail: Michael.Lell{at}idr.med.uni-erlangen.de

BACKGROUND AND PURPOSE: Bone-subtraction techniques have been shown to enhance CT angiography (CTA) interpretation, but motion can lead to incomplete bone removal. The aim of this study was to evaluate 2 novel registration techniques to compensate for patient motion.

MATERIALS AND METHODS: Fifty-four patients underwent bone-subtraction CTA (BSCTA) for the evaluation of the neck vessels with 64-section CT. We tested 3 different registration procedures: pure rigid registration (BSCTA), slab-based registration (SB-BSCTA), and a partially rigid registration (PR-BSCTA) approach. Subtraction quality for the assessment of different vascular segments was evaluated by 2 examiners in a blinded fashion. The Cohen kappa test was applied for interobserver variability, and the Wilcoxon signed rank test, for differences between the procedures. Motion between the corresponding datasets was measured and plotted against image-quality scores.

RESULTS: Algorithms with motion compensation revealed higher image-quality scores (SB-BSCTA, mean 4.31; PR-BSCTA, mean 4.43) than pure rigid registration (BSCTA, mean 3.88). PR-BSCTA was rated superior to SB-BSCTA for the evaluation of the cervical internal and external carotid arteries (P < .001), whereas there was no significant difference for the other vessels (P = .157–.655). Both algorithms were clearly superior to pure rigid registration for all vessels except the basilar and ophthalmic artery. Interobserver agreement was high ( = 0.46–0.98).

CONCLUSION: Bone-subtraction algorithms with motion compensation provided higher image-quality scores than pure rigid registration methods, especially in cases with complex motion. PR-BSCTA was rated superior to SB-BSCTA in the visualization of the internal and external carotid arteries.