Fig 1.
The flowchart of the CE-boost technique.
The iodinated image was obtained by subtracting the contrast-enhanced image from the pre-contrast image (1). The contrast enhancement (CE)-boost images were then generated by combining the subtracted iodinated image and contrast-enhanced image through automatic denoising procedure (2).
Table 1.
Subjective image analysis scoring.
Fig 2.
The CT attenuations between CE-boost and conventional images from the different anatomical regions.
CE-boost technique resulted in significantly higher CT attenuation than the conventional images from the different anatomical regions including PCA, basilar artery, pre-foraminal segments of the vertebral artery, foraminal segments of the vertebral artery, extradural segments of the vertebral artery, and intradural segments of the vertebral artery.
Fig 3.
The results of SNR and CNR from the different anatomical regions.
The mean value of SNR was significantly improved from 64.43 ± 17.17 with conventional images to 121.37 ± 38.77 with CE-boost, p < 0.001, while the mean value of CNR was also significantly increased 56.90 ± 18.79 with conventional image to 116.65 ± 57.44 with CE-boost, p < 0.001.
Fig 4.
The SNR map between CE-boost and conventional images.
CE-boost technique induced an improvement in the SNR values in the arteries of the posterior fossa especially in the basilar artery and superior cerebellar artery (white arrow) compared to the conventional image.
Table 2.
The results of SNR and CNR: A comparison between CE-boost and conventional images.
Table 3.
The results of FMHW between conventional and CE-boost images.
Fig 5.
Results of the subjective image analysis between CE-boost and conventional images.
CE-boost technique performed better than the conventional images in terms of overall image quality, vascular delineation, and vessel sharpness. There was no significant difference in the motion artifact between the conventional and CE-boost images. All CE-boost and conventional images were scored more than three scores by both observers.
Fig 6.
The volume-rendered images of the arteries in the posterior fossa.
The CE-boost images showed clear visualization and improved completeness of the posterior inferior cerebellar arteries (red circle) and superior cerebellar arteries (green and blue circle) than conventional images on both sides.
Fig 7.
Representative case of a 60-year-old woman with a right posterior inferior cerebellar aneurysm.
CE-boost showed a well demonstration of the distal segments (green arrow) of the right posterior inferior cerebellar artery distal to the aneurysm (red arrow) in a 3D angiogram compared to the conventional image. The values of the window width and level were the same between the two images.