Photon-counting CT imaging of a patient with coiled and untreated intracranial saccular aneurysms

We describe a novel application of photon-counting detector CT (PCD-CT) in neurovascular imaging by harnessing the improved spatial resolution, attenuation of electronic noise, and reduction of metal artifacts. The presented case offers the unique challenge of high-quality imaging for the assessment of treated and untreated intracranial saccular aneurysms, in the setting of metal artifacts from embolization coils. Our goal was to explore optimized reconstruction parameters for ultra-high-resolution imaging (UHR) using a dedicated, sharp neurovascular kernel (Hv72) and the highest strength of quantum iterative reconstruction (QIR-4) for detailed characterization of the vasculature. Virtual monoenergetic images (VMIs) and iterative metal artifact reduction (IMAR) were employed to investigate metal artifact reduction techniques. PCD-CT has the promising potential to enhance patient care in the follow-up of patients with treated aneurysms requiring more complex imaging parameters and image post-processing due to intracranial artifacts.