For clear visualization of vessels in CT angiography (CTA) images of the head and neck using maximum intensity projection (MIP) or volume rendering (VR) bone has to be removed. In the past we presented a fully automatic method to mask the bone [matched mask bone elimination (MMBE)] for this purpose. A drawback is that vessels adjacent to bone may be partly masked as well. We propose a modification, multiscale MMBE, which reduces this problem by using images at two scales: a higher resolution than usual for image processing and a lower resolution to which the processed images are transformed for use in the diagnostic process. A higher in-plane resolution is obtained by the use of a sharper reconstruction kernel. The out-of-plane resolution is improved by deconvolution or by scanning with narrower collimation. The quality of the mask that is used to remove bone is improved by using images at both scales. After masking, the desired resolution for the normal clinical use of the images is obtained by blurring with Gaussian kernels of appropriate widths. Both methods (multiscale and original) were compared in a phantom study and with clinical CTA data sets. With the multiscale approach the width of the strip of soft tissue adjacent to the bone that is masked can be reduced from 1.0 to 0.2 mm without reducing the quality of the bone removal. The clinical examples show that vessels adjacent to bone are less affected and therefore better visible. Images processed with multiscale MMBE have a slightly higher noise level or slightly reduced resolution compared with images processed by the original method and the reconstruction and processing time is also somewhat increased. Nevertheless, multiscale MMBE offers a way to remove bone automatically from CT angiography images without affecting the integrity of the blood vessels. The overall image quality of MIP or VR images is substantially improved relative to images processed with the original MMBE method.
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