The assessment of intracranial bleeding with virtual unenhanced imaging by means of dual-energy CT angiography

Eur Radiol. 2009 Oct;19(10):2518-22. doi: 10.1007/s00330-009-1495-2. Epub 2009 Jul 8.


The purpose of this study was to assess virtual unenhanced brain computed tomography (CT) images obtained by dual-energy CT angiography (CTA) for the detection of intracranial bleeding. In total, 25 patients were included in the study (average age 53.2 years, range 25-75 years, 14 male, 11 female), all with intracranial bleeding on unenhanced brain CT and who underwent additional CTA performed on a dual-source CT in a dual-energy acquisition mode. The two X-ray tubes were operated at 140 and 80 kV, respectively. Data were analyzed using dual-energy evaluation software. Virtual unenhanced images were calculated by removing the relative iodine content from each voxel. The virtual unenhanced images were evaluated by a radiologist blinded to the findings of the conventional images related to the presence of intracranial bleeding. The image quality and contrast-to-noise ratio (CNR) between bleeding and brain tissue were assessed. The virtual image quality was found to be sufficient in 96%. The agreement in detection of intracranial bleeding on virtual and conventional unenhanced images reached 96% in per-lesion analysis and 100% in per-patient analysis. The averaged CNR reached 2.63 in virtual unenhanced images and 3.27 in conventional. Virtual unenhanced images are sufficient for the detection of intracranial bleeding.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Absorptiometry, Photon / methods*
  • Adult
  • Aged
  • Cerebral Angiography / methods*
  • Contrast Media
  • Female
  • Humans
  • Image Enhancement / methods
  • Intracranial Hemorrhages / diagnostic imaging*
  • Iodine
  • Male
  • Middle Aged
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Tomography, X-Ray Computed / methods*
  • User-Computer Interface*


  • Contrast Media
  • Iodine