Dual-energy computed tomography angiography for lenticulostriate arteries: Stepwise optimization of virtual...

The lenticulostriate arteries (LSAs) are critical perforating vessels, but conventional CTA poorly depicts them. Dual-Energy CT offers Virtual Monochromatic Imaging and kernel adjustment, yet the optimal strategy for LSAs visualization remains unclear.

This retrospective study included 556 patients (59 [46-72] years; 310 males [55.8%]) who underwent DE-CTA between May 2023 to July 2024. Images were reconstructed Virtual Monochromatic Imaging at 40-90 KeV and multiple convolution kernels (Qr40, Hv36, Hv40, Hv44, and Hv49). Step 1 compared image quality across KeV levels, and Step 2 optimized kernels on the basis of the best KeV and compared these optimized reconstructions again. Quantitative metrics included CT value, SNR, CNR, edge rise distance, and edge rise slope; qualitative assessment and visible LSAs branch counts were performed.

Step 1 demonstrated significant differences in CT value, and CNR across KeV levels (all p < 0.001), with 40 KeV yielding the highest CT value and CNR and the best subjective scores for artery branches visualization. Step 2 showed that sharper kernels significantly improved ERS and reduced ERD, with Hv49-40 KeV achieving the greatest edge sharpness (ERS, 10374.4 [7407.0-13341.9]; ERD, 0.10 [0.08-0.13]) and the highest number of visible LSAs branches (6.5 [2.5-10.5]; all adjusted p < . 001).

Hv49-40KeV on DE‑CTA of the head and neck substantially improves the visualization of arteries across different calibers, with a marked enhancement in the depiction of the LSAs, providing a solid technical foundation for the evaluation of LSAs with DE‑CT.

This optimized Dual Energy-CT angiography reconstruction increases the utility of head and neck CTA by improving lenticulostriate artery visualization, thereby supporting routine evaluation of both large and small cerebral vessels in clinical practice.