(2026) Huijberts | Visualisation of lenticulostriate arteries using PCCT

Daniel Stromer

In this retrospective cohort of 159 patients with subarachnoid haemorrhage, UHR PCCT substantially improved lenticulostriate artery (LSA) visualization compared with conventional EID-CTA. For branches arising >5 mm from the MCA origin, PCCT detection approached DSA—for example, 93% vs 85% for observer 1 in the left hemisphere (p = 0.62)—while EID-CTA detected only 49% in the unpaired comparison.

PCCT remained inferior to DSA for depicting the full distal extent of larger LSA branches. Median LSA length >5 mm from the MCA origin was 23 mm on PCCT vs 40 mm on DSA for observer 1, whereas PCCT nevertheless showed significantly longer measurable branches than EID-CTA (23 vs 15 mm, p < 0.001).

The main technical trade-off was dose: the optimized 90-kVp, 0.2-mm UHR PCCT protocol achieved markedly better small-vessel visualization, but CTDIvol ranged 17–27 mGy, above the reported EID-CTA ranges. Thus, PCCT appears promising as a non-invasive alternative for LSA assessment, but DSA remains superior for the most distal branches and prospective clinical validation is needed.

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SUPPLEMENTAL APPENDIX

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Figure 2. LSA visualisation on DSA, EID-CTA and PCD-CT Note: (A) Rotational angiography; (B) Conventional anterior-to-posterior imaging; (C) 3D angiography cone beam CT (D) Second-generation dual source EID-CTA [flash]; (E) Third-generation dual source EID-CTA [force]; (F) PCD-CT.

Table S1: Detailed information on employed CTA imaging protocols

Protocol

Detail	Value
Scanner	NAEOTOM Alpha
Scan area	Intracranial CTA / lenticulostriate arteries
Acquisition mode	UHR
Tube voltage [kVp]	90
Tube current-time product [mAs]	250–330
CTDIvol [mGy]	17–27
Rotation time [s]	0.25
Pitch	0.4
Detector slice collimation	120 × 0.2 mm
Reconstruction slice thickness [mm]	0.2
Kernels	Hv40, Hv72, Bv40
Spectral reconstruction	Polychromatic T3D
Image analysis	Coronal MIP with reader-adjustable slab thickness, angulation, and window/level
LSA assessment	Presence, number, length, and subjective image quality
Reference standard	DSA, including rotational angiography, AP angiography, and/or 3D cone-beam angiography

Key Results

Parameter	Main finding
Study population	159 patients
PCCT vs DSA detection, LSA >5 mm	Observer 1: 93% vs 85%, p = 0.62; Observer 2: 78% vs 78%, p = 1.00
PCCT vs EID-CTA detection, LSA >5 mm	Observer 1: 93% vs 49%, p < 0.001; Observer 2: 79% vs 55%, p = 0.03
LSA length >5 mm, PCCT vs DSA	Observer 1: 23 [21–29] vs 40 [34–49] mm, p < 0.001
LSA length >5 mm, PCCT vs EID-CTA	Observer 1: 23 [19–28] vs 15 [9–22] mm, p < 0.001
Inter-reader reliability	Generally poor-to-moderate; PCCT left-hemisphere length ICC 0.610

Source:
Huijberts I, Wagemans BAJM, Pinckaers FME, Robbe MMQ, van Zwam WH, van Oostenbrugge RJ, Postma AA. Visualisation of lenticulostriate arteries using photon counting detector CT angiography: A retrospective cohort study. European Journal of Radiology. 2026;195:112618. doi:10.1016/j.ejrad.2025.112618.