European Radiology

, Volume 30, Issue 1, pp 163–174 | Cite as

Clinical impact of a new cone beam CT angiography respiratory motion artifact reduction algorithm during hepatic intra-arterial interventions

  • Marco Dioguardi Burgio
  • Thomas Benseghir
  • Vincent Roche
  • Carmela Garcia Alba
  • Jean Baptiste Debry
  • Annie Sibert
  • Valérie Vilgrain
  • Maxime RonotEmail author



To assess the impact of recently developed respiratory motion correction software on contrast-enhanced cone beam CT angiography (CBCT-a) for intraprocedural image guidance during intra-arterial liver-directed therapy.


From 2015 to 2017, two groups of patients who underwent intra-arterial liver-directed therapy with (breathing, n = 30) or without (still, n = 30) significant respiratory motion artifacts were retrospectively included. All CBCT-a were processed with and without dedicated respiratory motion correction software. Four readers independently assessed the following in both reconstructions (motion correction ON and OFF): (1) overall image quality on a 0-to-5 point scale, and (2) presence of relevant peri-procedural information on tumor and vasculature (overall vessel geometry, visibility of extrahepatic vessels, target tumor conspicuity, visibility of tumor feeders).


Motion correction increased the average image quality in the breathing group from 2.0 ± 0.9 to 2.9 ± 1.0 (p < 0.01). The visibility of vessel geometry, extrahepatic vessels, and tumor feeders was significantly improved for all readers, and tumor conspicuity was improved for three readers. The average image quality was not significantly different between reconstructions in the still group (motion correction ON and OFF), for any of the readers (4.0 ± 0.6 vs 4.2 ± 0.6; p = 0.12). There was no change in the visibility of vessel geometry, extrahepatic vessels, tumor feeders, or tumor conspicuity for the four readers using the respiratory motion correction software in this group.


Using the dedicated respiratory motion correction software during intra-arterial liver-directed procedures increases the visualization of relevant peri-procedural information and image quality in CBCT-a corrupted by respiratory motion artifacts without affecting these elements in still CBCT-a.

Key Points

• The use of respiratory motion correction software could reduce the need for cone beam CT angiography acquisition retake.

• Motion correction software significantly increases the visibility of vessel geometry, extrahepatic vessels, and tumor feeders, as well as tumor conspicuity in cone beam CT angiography corrupted by respiratory motion artifacts.

• The use of respiratory motion correction software on cone beam CT angiography uncorrupted by respiratory motion artifact does not result in decreased image quality.


Cone beam CT Angiography Liver Chemoembolization 



Cone beam computed tomography angiography


Digital subtraction angiography


Maximum intensity projection


Selective internal radiotherapy


Trans-arterial chemoembolization



The authors would like to thank Yves Trousset for his help on this study.


This work is part of the HECAM (HEpatocellular CArcinoma Multi-technological) consortium project and received an institutional grant from “bpifrance.”

Compliance with ethical standards


The scientific guarantor of this publication is Marco Dioguardi Burgio.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.


• retrospective

• observational

• performed at one institution

Supplementary material

330_2019_6355_MOESM1_ESM.docx (24.9 mb)
ESM 1 (DOCX 25465 kb)


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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  1. 1.Department of RadiologyUniversity Hospitals Paris Nord Val de SeineClichyFrance
  2. 2.INSERM U1149, Centre de Recherche Biomédicale Bichat-BeaujonParisFrance
  3. 3.GE HealthcareBucFrance
  4. 4.University Paris DiderotParisFrance

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