Time-resolved C-arm cone beam CT angiography using SMART-RECON: quantification of temporal resolution and reconstruction accuracy

Time-resolved cone beam CT angiography (CBCTA) imaging in the interventional suite has the potential to identify occluded vessels and the collaterals of symptomatic ischemic stroke patients. However, traditional C-arm gantries offer limited rotational speed and thus the temporal resolution is limited when the conventional filtered backprojection (FBP) reconstruction is used. Recently, a model based iterative image reconstruction algorithm: Synchronized MultiArtifact Reduction with Tomographic reconstruction (SMART-RECON) was proposed to reconstruct multiple CBCT image volumes per short-scan CBCT acquisition to improve temporal resolution. However, it is not clear how much temporal resolution can be improved using the SMART-RECON algorithm or what the corresponding reconstruction accuracy is. In this paper, a novel fractal tree based numerical timeresolved angiography phantom with ground truth temporal information was introduced to quantify temporal resolution using a temporal blurring model analysis along with other two quantification metrics introduced to quantify reconstruction accuracy: the relative root mean square error (rRMSE) and the Kullback-Leibler Divergence (DKL). The quantitative results show that the temporal resolution is 0.8 s for SMART-RECON and 3.6 s for the FBP reconstruction. The reconstruction fidelity with SMART-RECON was substantially improved with the rRMSE improved by at least 70% and the DKL was improved by at least 40%.