TY - JOUR T1 - Contrast-Enhanced Angiographic Cone-Beam CT of Cerebrovascular Stents: Experimental Optimization and Clinical Application JF - American Journal of Neuroradiology JO - Am. J. Neuroradiol. SP - 137 LP - 144 DO - 10.3174/ajnr.A2239 VL - 32 IS - 1 AU - N.V. Patel AU - M.J. Gounis AU - A.K. Wakhloo AU - N. Noordhoek AU - J. Blijd AU - D. Babic AU - D. Takhtani AU - S.-K. Lee AU - A. Norbash Y1 - 2011/01/01 UR - http://www.ajnr.org/content/32/1/137.abstract N2 - BACKGROUND AND PURPOSE: With modern imaging techniques, visualization of neurovascular stents remains challenging. We present a method for contrast-enhanced C-arm CBCT that provides detailed and simultaneous visualization of neurovascular stents and host arteries. MATERIALS AND METHODS: CBCT was performed with a rotational angiography system by acquiring 620 projection frames over a 200° arc at 80 kVp and a total of 260 mAs. A superselective intra-arterial contrast injection protocol was optimized in swine experiments and implemented in 57 clinical examinations. High-resolution 3D reconstructions were evaluated by 3 blinded interventional neuroradiologists. Reviewers rated the images by answering questions related to both the quality of the stent and artery visualization and the clinical utility of the images. Raw agreement statistics, ICC, and κ statistics were computed for the questionnaire results. RESULTS: Of 57 clinical evaluations, 5 were not evaluated due to the use of large balloon-mounted stents (n = 4) and a failed contrast injection (n = 1). In 50 of 52 evaluated examinations, the reviewers agreed that simultaneous stent and vessel visualization was of diagnostic quality. There was strong agreement that stent–vessel wall apposition could be assessed (κ = 0.79). CBCT detected contrast filling defects (κ = 0.85) and vascular calcification (κ = 0.68). Artifacts resulting from the aneurysm coil mass impaired the delineation of adjacent structures (κ = 0.72). CONCLUSIONS: We have developed a technique that enables simultaneous clinically useful imaging of neurovascular stents and their host arteries that is unobtainable with other current imaging modalities. Further improvements are required to reduce artifacts from large coil masses due to x-ray scattering. ACAanterior cerebral arteryBESballoon-expandable stentsCBCTcone-beam CTDSAdigital subtraction angiographyFDAUS Food and Drug AdministrationICAinternal carotid arteryICCintraclass correlation coefficientMCAmiddle cerebral arteryMDCTmultidetector CTMIPmaximum intensity projectionMRAMR angiographyPICAposterior inferior cerebellar arterySESself-expanding stent ER -