Image Quality Evaluation for Brain Soft Tissue in Neuroendovascular Treatment by Dose-Reduction Mode of Dual-Axis "Butterfly" Scan

Hisayuki Hosoo; Yoshiro Ito; Koji Hirata; Mikito Hayakawa; Aiki Marushima; Tomohiko Masumoto; Hiroshi Yamagami; Yuji Matsumaru

doi:10.3174/ajnr.A8472

Image Quality Evaluation for Brain Soft Tissue in Neuroendovascular Treatment by Dose-Reduction Mode of Dual-Axis "Butterfly" Scan

AJNR Am J Neuroradiol. 2025 Jan 9. doi: 10.3174/ajnr.A8472. Online ahead of print.

Authors

Hisayuki Hosoo^{1

2

3}, Yoshiro Ito^{4

3}, Koji Hirata⁴, Mikito Hayakawa^{4

5}, Aiki Marushima^{4

3}, Tomohiko Masumoto⁶, Hiroshi Yamagami^{4

2}, Yuji Matsumaru^{4

3}

Affiliations

¹ From the Department of Stroke and Cerebrovascular Diseases (H.H., Y.I., K,H., A.M., H.Y., Y.M.), University of Tsukuba Hospital, Ibaraki, Japan hisayuki.hosoh@gmail.com.
² Division of Stroke Prevention and Treatment (H.H., H.Y.), University of Tsukuba, Ibaraki, Japan.
³ Department of Neurosurgery (H.H., Y.I., A.M., Y.M.), Institute of Medicine University of Tsukuba, Ibaraki, Japan.
⁴ From the Department of Stroke and Cerebrovascular Diseases (H.H., Y.I., K,H., A.M., H.Y., Y.M.), University of Tsukuba Hospital, Ibaraki, Japan.
⁵ Department of Neurology (M.H.), Institute of Medicine, University of Tsukuba, Ibaraki, Japan.
⁶ Department of Diagnostic Radiology (T.M.), Toranomon Hospital, Tokyo, Japan.

PMID: 39179299
DOI: 10.3174/ajnr.A8472

Abstract

Background and purpose: Flat panel conebeam CT (CBCT) is essential for detecting hemorrhagic complications during neuroendovascular treatments. Despite its superior image quality and trajectory over conventional CBCT (circular scan), the dual-axis butterfly scan has a slightly higher radiation dose relative to conventional CBCT. This study evaluates the image quality in dose-reduction mode to uncover the appropriate radiation dose for the butterfly scan.

Materials and methods: We prospectively included patients who were scheduled for neuroendovascular treatment and underwent conventional CBCT and the dose-reduction mode of the butterfly scan. Two reduced radiation dose modes were used for the butterfly scan: medium-dose butterfly scan (70% of the original dose, 45 mGy) or low-dose butterfly scan (50% of the original dose, 30 mGy). The enrolled patients were assigned alternately to undergo either the medium- or low-dose butterfly scan. We evaluated and compared artifacts, contrast, and discrimination of the corticomedullary junction between conventional CBCT and one of the dose-reduction modes of the butterfly scan, with a 5-point scale scoring system.

Results: Twenty patients were enrolled in each of the medium- and low-dose groups, totaling 40 patients. Compared with conventional CBCT, the medium-dose butterfly group exhibited reduced artifacts, enhanced contrast, and corticomedullary junction discrimination (except in the occipital lobe). While the low-dose butterfly group exhibited markedly reduced artifacts and improved contrast (except in the occipital lobe), a significant improvement in corticomedullary junction discrimination was not observed.

Conclusions: Even with dose reduction, the specialized trajectory of the butterfly scan enables artifact reduction, contrast improvement, and enhanced corticomedullary junction discrimination. However, the impact of the reduced dose was more noticeable, particularly in the occipital region where susceptibility to bone interference resulted in decreased contrast and compromised corticomedullary junction discrimination.