Abstract
Glioses appear as hypodense lesions in non-contrast CT examinations of the head. Photon counting CT (PCCT) enables the calculation of virtual monoenergetic images (VMI). The aim of this study is to investigate in which VMI hypodense gliotic lesions can be delineated best. 35 patients with an MRI-confirmed gliotic lesion and a non-contrast PCCT of the head were retrospectively included. All available VMI from 40keV to 190keV were calculated. In a quantitative analysis, conventional image quality parameters were calculated, in particular the contrast-to-noise ratio (CNR) of the hypodense lesion compared to the white matter. In a qualitative analysis, selected VMI were rated by experienced radiologists. The absolute maximum of CNR was 8.12 ± 5.64 in the VMI 134keV, in post hoc testing, there were significant differences in comparison to VMI with keV ≤110 and keV ≥180 (corrected p < .05). In the qualitative analysis, there were only very slight differences in the rating of the VMI with 66keV, 80keV, 100keV, and 134keV with overall low agreement between the readers. The quantitative superiority of VMI 134keV for the delineation of hypodense gliotic lesions did not translate into a superiority in the qualitative analysis. Therefore, it remains uncertain if the reconstruction of a high keV VMIs for the detection of hypodense gliotic lesions is useful in everyday clinical practice. However, more studies, are necessary to further assess this issue.
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