In this selected pilot cohort of 20 complex neurosurgical cases, UHR PCCT provided additional anatomical information beyond conventional MRI/CT, particularly for arterial anatomy (11/20, 55%), tumor vascular supply (7/20, 35%), venous anatomy (6/20, 30%), and skull-base/orbital/osseous involvement (8/20, 40%). The greatest apparent benefit was in complex skull-base meningiomas and vascular lesions.
The technical advantage was the combination of 0.2-mm-class UHR vascular imaging, bone-subtracted pure-lumen reconstructions, spectral imaging, and simultaneous osseous depiction. This allowed visualization of small-caliber vessels, tumor feeders, perforators, venous drainage, vessel encasement/displacement, and hyperostotic or transosseous tumor extension relevant to surgical navigation.
These results are explicitly hypothesis-generating rather than evidence of clinical superiority. The cohort was strongly selected—19 of 45 PCCT examinations were excluded because they showed no additional findings—and comparisons were unblinded and not validated systematically against operative or angiographic reference standards. The proposed role is therefore PCCT complementary to MRI, rather than replacing MRI for lesion characterization.
