Clinical impact of a new cone beam CT angiography respiratory motion artifact reduction algorithm during hepatic intra-arterial interventions

To assess the impact of recently developed respiratory motion correction software on contrast-enhanced cone beam CT angiography (CBCT-a) for intraprocedural image guidance during intra-arterial liver-directed therapy. From 2015 to 2017, two groups of patients who underwent intra-arterial liver-directed therapy with (breathing, n = 30) or without (still, n = 30) significant respiratory motion artifacts were retrospectively included. All CBCT-a were processed with and without dedicated respiratory motion correction software. Four readers independently assessed the following in both reconstructions (motion correction ON and OFF): (1) overall image quality on a 0-to-5 point scale, and (2) presence of relevant peri-procedural information on tumor and vasculature (overall vessel geometry, visibility of extrahepatic vessels, target tumor conspicuity, visibility of tumor feeders). Motion correction increased the average image quality in the breathing group from 2.0 ± 0.9 to 2.9 ± 1.0 (p < 0.01). The visibility of vessel geometry, extrahepatic vessels, and tumor feeders was significantly improved for all readers, and tumor conspicuity was improved for three readers. The average image quality was not significantly different between reconstructions in the still group (motion correction ON and OFF), for any of the readers (4.0 ± 0.6 vs 4.2 ± 0.6; p = 0.12). There was no change in the visibility of vessel geometry, extrahepatic vessels, tumor feeders, or tumor conspicuity for the four readers using the respiratory motion correction software in this group. Using the dedicated respiratory motion correction software during intra-arterial liver-directed procedures increases the visualization of relevant peri-procedural information and image quality in CBCT-a corrupted by respiratory motion artifacts without affecting these elements in still CBCT-a.