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Utility of follow-up ultra-high-resolution CT angiography with model-based iterative reconstruction after flow diverter treatment for cerebral aneurysms

  • Neuroradiology
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Abstract

Purpose

Follow-up examinations after flow diverter (FD) treatment for cerebral aneurysms typically involve magnetic resonance imaging (MRI) or digital subtraction angiography (DSA). However, MRI is prone to vascular defects due to metal artifacts from FD, and DSA carries a risk of ischemic complications. In the context of computed tomography angiography (CTA), this study compares the efficacy of ultra-high-resolution CT (UHRCT) and novel reconstruction techniques, such as model-based iterative reconstruction (MBIR), against conventional methods such as filtered back projection (FBP) and hybrid iterative reconstruction (IR), to determine if they are a viable alternative to DSA in clinical settings.

Materials and methods

A phantom study was conducted with the full-width half-maximum considered as the FD thickness. This study compared three reconstruction methods: MBIR, FBP, and hybrid IR. A clinical study was also conducted with 21 patients who underwent follow-up CTA after FD treatment. The FD’s visibility was assessed using a 4-point scale in FBP, hybrid IR, and MBIR compared to cone-beam CT (CBCT) with angiographic systems.

Results

In the phantom study, FBP, hybrid IR, and MBIR visualized thinner FD thicknesses and improved detail rendering in that order. MBIR proved to be significantly superior in both the phantom and clinical study.

Conclusion

UHRCT with MBIR is highly effective for follow-up evaluations after FD treatment and may become the first-choice modality in the future.

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The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Clinical Radiology, Tottori University Hospital, Tottori, Japan

    Naoki Iwata, Makoto Sakamoto, Toshio Sakou, Tetsuji Uno & Masamichi Kurosaki

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  1. Naoki Iwata
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by N.I., M.S., T.S., and T.U. The first draft of the manuscript was written by N.I. and all authors commented on previous versions of the manuscript. M.K. supervised the conduct of this study. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Naoki Iwata.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of the Tottori University Hospital (March 11, 2022; No.21A219).

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The authors affirm that human research participants provided informed consent for publication of the images in Figs. 4, 5, and 6.

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Informed consent was obtained from all individual participants included in the study.

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Iwata, N., Sakamoto, M., Sakou, T. et al. Utility of follow-up ultra-high-resolution CT angiography with model-based iterative reconstruction after flow diverter treatment for cerebral aneurysms. Radiol med 128, 1262–1270 (2023). https://doi.org/10.1007/s11547-023-01692-9

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