BACKGROUND AND PURPOSE: Three-dimensional rotational angiography (3D-RA) is a key modality in endovascular neurointerventions but often provides limited visibility of small, clinically relevant vessels such as perforating arteries. This study aimed to evaluate the performance of a novel, dedicated vessel enhancement software in improving vascular visibility in 3D-RA datasets. MATERIALS AND METHODS: In this retrospective analysis of a prospectively maintained institutional database, fifty consecutive patients with unruptured anterior circulation aneurysms underwent standardized 3D-RA acquisitions on the ARTIS icono angiographic system (Siemens Healthineers). Each dataset was reconstructed with and without vessel enhancement. Quantitative analysis comprised contrast-to-noise ratio (CNR) measurements in the M1 segment of the middle cerebral artery and in perforating branches. Qualitative image quality was independently assessed by two experienced readers on a five-point scale. RESULTS: Vessel enhancement yielded consistent improvements across all analyses. CNR increased in the M1 segment (mean CNR ± standard deviation (SD), no vessel enhancement (N-VE): 25.15±5.42 vs. VE: 27.85±5.41, p<0.001) and in perforating arteries (mean CNR ± SD, N-VE: 22.26±4.57 vs. VE: 24.80±4.75, p<0.001). Overall qualitative ratings improved from "very good" to "excellent" diagnostic quality, with higher scores for vessel-enhanced reconstructions compared with unenhanced images (mean score ± SD, N-VE: 3.90±0.65 vs. VE: 4.66±0.52, p<0.001). Improvements were particularly evident for the continuity and visibility of fine vascular structures. Inter-reader agreement was good (
