Virtual Non-Contrast versus True Native in Photon-Counting CT: Stability of Density of Upper Abdominal Organs and Vessels

The clinical use of photon-counting CT (PCCT) allows for the generation of virtual non-contrast (VNC) series from contrast-enhanced images. In routine clinical practice, specific issues such as ruling out acute bleeding require non-contrast images. The aim of this study is to evaluate the use of PCCT-derived VNC reconstructions in abdominal imaging. PCCT scans of 17 patients including early arterial, portal venous and native sequences were enrolled. VNC reconstructions have been calculated. In every sequence and VNC reconstruction, 10 ROIs were measured (portal vein, descending aorta, inferior vena cava, liver parenchyma, spleen parenchyma, erector spinae muscle, subcutaneous adipose tissue, first lumbar vertebral body, air, and psoas muscle) and density values were compared. The VNC reconstructions show significant changes in density compared to the contrast-enhanced images. However, there were no significant differences present between the true non-contrast (TNC) and any VNC reconstructions in the observed organs and vessels. Significant differences (p < 0.05) between the measured mean density values in the TNC versus VNC reconstructions were found in fat and bone tissue. The PCCT-derived VNC reconstructions seemed to be comparable to the TNC images, despite some deviations shown in the adipose tissue and bone structures. However, the further benefits in terms of specific clinical issues need to be evaluated.