Article Figures & Data
Figures
- Fig 1.
Comparison of BSCTA with rigid registration BSCTA, SB-BSCTA, and PR-BSCTA: CTA (MIP) shows a patient with high-grade stenosis of left ICA. Rigid registration leads to insufficient removal of the lower cervical spine (A, Lateral. B, Frontal projection). The edges of the individual registration slabs from SB-BSCTA (C and D) can be identified by the bone remnants from the mandible and cervical spine (arrows). Weighting of total bone mass within each slab is performed in this algorithm, explaining the distribution of the bone remnants. PR-BSCTA (E and F) demonstrates almost complete elimination of the bone pixels from the mandible and cervical spine. The thyroid cartilage remains misregistered with both approaches.
- Fig 2.
CTA (MIP, frontal [A and C] and lateral [B and D] views) shows a patient with atherosclerotic disease at the carotid bifurcation and siphon. Correct registration and successful removal of the calcified plaque at the carotid siphon is obtained with both registration techniques. Pulsation leads to incomplete removal at the left carotid bifurcation, more pronounced with SB-BSCTA (A and B), whereas removal of the calcifications at the right carotid bifurcation is almost perfect with both methods. Removal of the lower cervical spine is more complete with SB-BSCTA compared with PR-BSCTA (C and D). The OA (arrow) can be identified with both approaches. The right ECA is occluded.
- Fig 3.
CTA (MIP, frontal [A and C] and lateral [B and D] views) shows a patient with occlusion of the right carotid artery and steno-occlusive disease at the left carotid bifurcation and right VA. Both registration techniques provide excellent image quality; more bone remnants can be depicted with SB-BSCTA (A and B) in comparison with PR-BSCTA (C and D) in this patient.
- Fig 4.
Graphic representation of the individual motion amplitudes for each patient. Note that the patients are ranked by increasing complexity of motion. Trend lines indicate the displacement of different anatomic landmarks.
- Fig 5.
Graphic representation (and trend lines) of the quality scores achieved with the different techniques for individual vessels (A, VA. B, Cervical ICA. C, PC-ICA). There is a trend toward decreased image quality with increasing complexity of motion, expressed by the SD of the motion amplitudes except for the PC-ICA.
Tables
- Table 1:
Summary of quality scores for angiograms processed with pure rigid BSCTA, SB-BSCTA, and PR-BSCTA
Vessel BSCTA SB-BSCTA PR-BSCTA Mean ±SD Med Range Mean ±SD Med Range Mean ±SD Med Range CCA Reader 1 3.50 1.1 4 1–5 4.41 0.65 4.5 3–5 4.33 0.64 4 3–5 Reader 2 3.50 1.1 4 1–5 4.24 0.66 4 3–5 4.37 0.59 4 3–5 ICA Reader 1 3.48 0.81 3.5 2–5 3.96 0.79 4 2–5 4.26 0.64 4 3–5 Reader 2 3.48 0.81 3.5 2–5 3.89 0.74 4 2–5 4.20 0.65 4 3–5 ECA Reader 1 3.43 0.83 3 2–5 3.91 0.75 4 3–5 4.30 0.60 4 3–5 Reader 2 3.46 0.88 3.5 2–5 3.78 0.71 4 3–5 4.24 0.61 4 3–5 PC-ICA Reader 1 4.65 0.51 5 3–5 4.92 0.27 5 4–5 4.87 0.34 5 4–5 Reader 2 4.61 0.56 5 3–5 4.81 0.39 5 4–5 4.79 0.41 5 4–5 VA Reader 1 2.50 1.1 3 1–5 3.50 0.83 4 2–5 3.50 0.88 4 1–5 Reader 2 2.52 1.1 3 1–5 3.61 0.70 4 2–5 3.74 0.75 4 2–5 BA Reader 1 4.90 0.3 5 4–5 4.98 0.14 5 4–5 4.96 0.19 5 4–5 Reader 2 4.88 0.33 5 4–5 4.92 0.27 5 4–5 4.96 0.19 5 4–5 OA Reader 1 4.80 0.68 5 1–5 4.83 0.67 5 1–5 4.83 0.67 5 1–5 Reader 2 4.60 0.92 5 1–5 4.63 0.91 5 1–5 4.70 0.81 5 1–5 Note:—Med indicates median.
- Table 2:
Influence of the 3 registration procedures on image quality of different vessels (P values, Wilcoxon test)*
Vessel Reader 1 Reader 2 BSCTA vs SB-BSCTA BSCTA vs PR-BSCTA SB-BSCTA vs PR-BSCTA BSCTA vs SB-BSCTA BSCTA vs PR-BSCTA SB-BSCTA vs PR-BSCTA CCA .000 .000 .353 .000 .000 .052 ICA .000 .000 .003 .000 .000 .001 ECA .000 .000 .000 .002 .000 .000 PC-ICA .001 .007 .180 .050 .104 .564 VA .000 .000 .870 .000 .000 .108 BA .103 .180 .564 .414 .103 .157 OA .317 .564 1.0 .317 .157 .317 * Differences between bone subtraction without and with motion compensation are statistically significant for all vessels except for the BAs and OAs; differences between SB- and PR-BSCTA are statistically significant for the ECA and the cervical ICA.
- Table 3:
Interobserver agreement for the assessment of the vascular segments with 3 registration algorithms*
BSCTA SB-BSCTA PR-BSCTA CCA 0.95 0.73 0.80 ICA 0.97 0.91 0.93 ECA 0.95 0.81 0.72 PC-ICA 0.87 0.52 0.60 VA 0.98 0.82 0.69 BA 0.90 0.64 0.46 OA 0.68 0.67 0.70 * The kappa values indicate high overall interobserver agreement for the assessment of the different vascular segments.
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