Purpose This study aimed to explore the efficacy and versatility of contrast enhancement boost (CE-Boost) technology for enhancing blood vessels with varying phases and degrees of enhancement on cranial four-dimensional computed tomography angiography (4D-CTA). Materials and Methods: Forty-three patients who underwent cerebral CT perfusion (CTP) were enrolled retrospectively. For each patient, three single-phase images were selected from the 4D-CTA based on subjective scoring criteria: one image was scored as arterial early phase non-diagnostic (insufficient enhancement for clinical diagnosis), and two images were scored as arterial phase diagnostic (sufficient enhancement for clinical diagnosis). Subsequently, the corresponding CE-Boost group images were generated using subtraction software. Measurements were obtained on the normal side in six image groups, including: the middle cerebral artery (MCA) M1 segment, basilar artery (BA), and brainstem (BS). Objective image quality was assessed using the CT value, image noise, signal-to-noise ratio (SNR), and contrast noise ratio (CNR). The subjective image quality was assessed using a five-point Likert scale.

Results The CT attenuation value, noise value, SNR, and CNR of the MCA and BA were significantly higher in the CE-Boost group than in the original images (all P<0.001). The subjective score of the CE-Boost group was higher than that of the original image (3.59±1.33 versus 2.92±0.95, P<0.001).

Conclusion The CE-Boost technique can improve the objective image quality of arterial phase diagnostic images of intracranial 4D-CTA while improving the visualization of branch vessels. However, arterial early phase non-diagnostic images only improve the objective evaluation of the trunk and have limited ability to improve the visualization of intracranial branch vessels. This study suggests that the CE-Boost technique is suitable for arterial phase diagnostic images with an intracranial subjective score greater than or equal to 3.