Virtual monoenergetic images by spectral detector computed tomography may improve image quality and diagnostic ability for ischemic lesions in acute ischemic stroke

Background Acute ischemic lesions are challenging to detect by conventional computed tomography (CT). Virtual monoenergetic images may improve detection rates by increased tissue contrast. Purpose To compare the ability to detect ischemic lesions of virtual monoenergetic with conventional images in patients with acute stroke. Material and Methods We included consecutive patients at our center that underwent brain CT in a spectral scanner for suspicion of acute stroke, onset Results In total, 29 patients were included (January 2018 to July 2019). SNR was higher in virtual monoenergetic compared to conventional images, significantly at 60–150 keV. CNR between ischemic gray and normal white matter was higher in monoenergetic images at 40–70 keV compared to conventional images. Virtual monoenergetic images received higher scores in overall image quality. The sensitivity for diagnosing acute ischemia was 93% and 97%, respectively, for the reviewers, compared to 55% of the original report based on conventional images. Conclusion Virtual monoenergetic reconstructions of spectral CIs may improve image quality and diagnostic ability in stroke assessment.