A novel spectral black-blood CT (BBCT) reconstruction used the spectral information from PCCT to suppress intraluminal iodine from a routine single-phase CTA dataset, enabling high-resolution carotid vessel wall imaging without an additional scan, contrast administration, or dedicated acquisition.
Compared with conventional CTA, spectral BBCT significantly improved wall–lumen delineation and carotid plaque conspicuity while preserving overall image quality. An iodine ratio of 2.0 provided the best balance between lumen suppression and vessel wall visualization.
BBCT improved reader agreement for high-risk plaque features including intraplaque hemorrhage, lipid-rich necrotic core, and thin fibrous cap. However, possible subtraction-related sensitivity loss means BBCT should currently be viewed as a complementary PCCT reconstruction alongside conventional CTA, rather than a standalone replacement.
