The metrics of FOR, LIRS, and the product of the two metrics provided the highest agreement in motion artifact ranking when compared to the readers, and the highest linear correlation to the reader scores. The validated motion artifact metrics may be useful for developing and evaluating methods to reduce motion in Coronary Computed Tomography Angiography (CCTA) images.

Abstract:Purpose: Reconstructing a low-motion cardiac phase is expected to improve coronary artery visualization in coronary computed tomography angiography (CCTA) exams. This study developed an automated algorithm for selecting the optimal cardiac phase for CCTA reconstruction. The algorithm uses prospectively gated, single-beat, multiphase data made possible by wide cone-beam imaging. The proposed algorithm differs from previous approaches because the optimal phase is identified based on vessel image quality (IQ) directly, compared to previous approaches that included motion estimation and interphase processing. Because there is no processing of interphase information, the algorithm can be applied to any sampling of image phases, making it suited for prospectively gated studies where only a subset of phases are available. Methods: An automated algorithm was developed to select the optimal phase based on quantitative IQ metrics. For each reconstructed slice at each reconstructed phase, an image quality metric was calculated based on measures of circularity and edge strength of through-plane vessels. The image quality metric was aggregated across slices, while a metric of vessellocation consistency was used to ignore slices that did not contain throughplane vessels. The algorithm performance was evaluated using two observer studies. Fourteen single-beat cardiacCT exams (Revolution CT, GE Healthcare, Chalfont St. Giles, UK) reconstructed at 2% intervals were evaluated for best systolic (1), diastolic (6), or systolic and diastolic phases (7) by three readers and the algorithm. Pairwise inter-reader and reader-algorithm agreement was evaluated using the mean absolute difference (MAD) and concordance correlation coefficient (CCC) between the reader and algorithm-selected phases. A reader-consensus best phase was determined and compared to the algorithm selected phase. In cases where the algorithm and consensus best NOT THE PUBLISHED VERSION; this is the author's final, peer-reviewed manuscript. The published version may be accessed by following the link in the citation at the bottom of the page. 3 phases differed by more than 2%, IQ was scored by three readers using a five point Likert scale. Results: There was no statistically significant difference between inter-reader and reader-algorithm agreement for either MAD or CCC metrics (p > 0.1). The algorithm phase was within 2% of the consensus phase in 15/21 of cases. The average absolute difference between consensus and algorithm best phases was 2.29% ± 2.47%, with a maximum difference of 8%. Average image quality scores for the algorithm chosen best phase were 4.01 ± 0.65 overall, 3.33 ± 1.27 for right coronary artery (RCA), 4.50 ± 0.35 for left anterior descending (LAD) artery, and 4.50 ± 0.35 for left circumflex artery (LCX). Average image quality scores for the consensus best phase were 4.11 ± 0.54 overall, 3.44 ± 1.03 for RCA, 4.39 ± 0.39 for LAD, and 4.50 ± 0.18 for LCX. There was no statistically significant difference (p > 0.1) between the image quality scor...

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Purpose This study developed and validated a Motion Artifact Quantification algorithm to automatically quantify the severity of motion artifacts on coronary computed tomography angiography (CCTA) images. The algorithm was then used to develop a Motion IQ Decision method to automatically identify whether a CCTA dataset is of sufficient diagnostic image quality or requires further correction. Method The developed Motion Artifact Quantification algorithm includes steps to identify the right coronary artery (RCA) regions of interest (ROIs), segment vessel and shading artifacts, and to calculate the motion artifact score (MAS) metric. The segmentation algorithms were verified against ground‐truth manual segmentations. The segmentation algorithms were also verified by comparing and analyzing the MAS calculated from ground‐truth segmentations and the algorithm‐generated segmentations. The Motion IQ Decision algorithm first identifies slices with unsatisfactory image quality using a MAS threshold. The algorithm then uses an artifact‐length threshold to determine whether the degraded vessel segment is large enough to cause the dataset to be nondiagnostic. An observer study on 30 clinical CCTA datasets was performed to obtain the ground‐truth decisions of whether the datasets were of sufficient image quality. A five‐fold cross‐validation was used to identify the thresholds and to evaluate the Motion IQ Decision algorithm. Results The automated segmentation algorithms in the Motion Artifact Quantification algorithm resulted in Dice coefficients of 0.84 for the segmented vessel regions and 0.75 for the segmented shading artifact regions. The MAS calculated using the automated algorithm was within 10% of the values obtained using ground‐truth segmentations. The MAS threshold and artifact‐length thresholds were determined by the ROC analysis to be 0.6 and 6.25 mm by all folds. The Motion IQ Decision algorithm demonstrated 100% sensitivity, 66.7% ± 27.9% specificity, and a total accuracy of 86.7% ± 12.5% for identifying datasets in which the RCA required correction. The Motion IQ Decision algorithm demonstrated 91.3% sensitivity, 71.4% specificity, and a total accuracy of 86.7% for identifying CCTA datasets that need correction for any of the three main vessels. Conclusion The Motion Artifact Quantification algorithm calculated accurate (<10% error) motion artifact scores using the automated segmentation methods. The developed algorithms demonstrated high sensitivity (91.3%) and specificity (71.4%) in identifying datasets of insufficient image quality. The developed algorithms for automatically quantifying motion artifact severity may be useful for comparing acquisition techniques, improving best‐phase selection algorithms, and evaluating motion compensation techniques.

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