Accelerated intracranial time-of-flight MR angiography with image-based deep learning image enhancement reduces scan times and improves image quality at 3-T and 1.5-T

Purpose Three-dimensional time-of-flight magnetic resonance angiography (TOF-MRA) is effective for cerebrovascular disease assessment, but clinical application is limited by long scan times and low spatial resolution. Recent advances in deep learning-based reconstruction have shown the potential to improve image quality and reduce scan times. This study aimed to evaluate the effectiveness of accelerated intracranial TOF-MRA using deep learning-based image enhancement (TOF-DL) compared to conventional TOF-MRA (TOF-Con) at both 3-T and 1.5-T. Materials and methods In this retrospective study, patients who underwent both conventional and 40% accelerated TOF-MRA protocols on 1.5-T or 3-T scanners from July 2022 to March 2023 were included. A commercially available DL-based image enhancement algorithm was applied to the accelerated MRA. Quantitative image quality assessments included signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), contrast ratio (CR), and vessel sharpness (VS), while qualitative assessments were conducted using a five-point Likert scale. Cohen's d was used to compare the quantitative image metrics, and a cumulative link mixed regression model analyzed the readers' scores. Results A total of 129 patients (mean age, 64 years +/- 12 [SD], 99 at 3-T and 30 at 1.5-T) were included. TOF-DL showed significantly higher SNR, CNR, CR, and VS compared to TOF-Con (CNR = 183.89 vs. 45.58; CR = 0.63 vs. 0.59; VS = 0.73 vs. 0.61; all p < 0.001). The improvement in VS was more pronounced at 1.5-T (Cohen's d = 2.39) compared to 3-T HR and routine (Cohen's d = 0.83 and 0.75, respectively). TOF-DL also outperformed TOF-Con in qualitative image parameters, enhancing the visibility of small- and medium-sized vessels, regardless of the degree of resolution and field strength. TOF-DL showed comparable diagnostic accuracy (AUC: 0.77-0.85) to TOF-Con (AUC: 0.79-0.87) but had higher specificity for steno-occlusive lesions. CONCLUSIONS Accelerated intracranial MRA with deep learning-based reconstruction reduces scan times by 40% and significantly enhances image quality over conventional TOF-MRA at both 3-T and 1.5-T.