Guided noise reduction with streak removal for high speed flat detector CT perfusion

Tissue perfusion measurement using C-arm angiography systems capable of CT-like imaging (flat detector CT (FD-CT)) is a novel technique with high potential benefit for catheter-guided treatment of stroke in the interventional suite. New high speed protocols (HSP) with increased C-arm rotation speed enable fast acquisitions of FD-CT volumes and allow for sampling the contrast flow with improved temporal resolution. However, the peak contrast attenuation values of brain tissue typically lie in a range of 5-30 HU. Thus perfusion imaging is very sensitive to noise. Recently we introduced the FDK-JBF denoising technique based on Feldkamp (FDK) reconstruction followed by denoising in volume space using joint bilateral filtering (JBF). In the evaluation FDK-JBF achieved comparable results to algebraic techniques, but is computationally less costly. Yet the angular sampling of the projection data in the HSP is coarse, which leads to streak artifacts in the reconstructed volumes. Mask volumes are subtracted from the contrast agent enhanced (bolus) volumes and the streak artifacts are subtracted out if the patient does not move during the acquisition. However, in case of motion the streak artifacts will not be identical in the mask and bolus volumes. We show that these streaks can lead to severe artifacts in the perfusion maps and describe a novel technique for streak removal (SR), which is based on streak detection by using time-contrast curve analysis.We evaluated the FDK-SR-JBF algorithm in a phantom and a patient study and show that noise and streaks can be reduced within a short computation time.