Residual Motion Correction in Low-Dose Myocardial CT Perfusion Using CNN-Based Deformable Registration

Dynamic myocardial CT perfusion imaging enables functional assessment of coronary artery stenosis and myocardial microvascular disease. However, it is susceptible to residual motion artifacts arising from cardiac and respiratory activity. These artifacts introduce temporal misalignments, distorting Time-Enhancement Curves (TECs) and leading to inaccurate myocardial perfusion measurements. Traditional nonrigid registration methods can address such motion but are often computationally expensive and less effective when applied to low-dose images, which are prone to increased noise and structural degradation. In this work, we present a CNN-based motion-correction framework specifically trained for low-dose cardiac CT perfusion imaging. The model leverages spatiotemporal patterns to estimate and correct residual motion between time frames, aligning anatomical structures while preserving dynamic contrast behaviour. Unlike conventional methods, our approach avoids iterative optimization and manually defined similarity metrics, enabling faster, more robust corrections. Quantitative evaluation demonstrates significant improvements in temporal alignment, with reduced Target Registration Error (TRE) and increased correlation between voxel-wise TECs and reference curves. These enhancements enable more accurate myocardial perfusion measurements. Noise from low-dose scans affects registration performance, but this remains an open challenge. This work emphasizes the potential of learning-based methods to perform effective residual motion correction under challenging acquisition conditions, thereby improving the reliability of myocardial perfusion assessment.