biostudies-literatureZhang FKey Project of the University of SanyaSpecial Program of Science and Technology for Colleges, Universities and Medical Institutions in SanyaHainan Provincial Natural Science Foundation of ChinaKey Research and Development Project of Hainan Province78https://www.ebi.ac.uk/biostudies/studies/S-EPMC11219652biostudies-literatureUnknown8(1)<h4>Background</h4>Computed tomography (CT) is the usual modality for diagnosing stroke, but conventional CT angiography reconstructions have limitations.<h4>Methods</h4>A phantom with tubes of known diameters and wall thickness was scanned for wall detectability, wall thickness, and contrast-to-noise ratio (CNR) on conventional and spectral black-blood (SBB) images. The clinical study included 34 stroke patients. Diagnostic certainty and conspicuity of normal/abnormal intracranial vessels using SBB were compared to conventional. Sensitivity/specificity/accuracy of SBB and conventional were compared for plaque detectability. CNR of the wall/lumen and quantitative comparison of remodeling index, plaque burden, and eccentricity were obtained for SBB imaging and high-resolution magnetic resonance imaging (hrMRI).<h4>Results</h4>The phantom study showed improved detectability of tube walls using SBB (108/108, 100% versus conventional 81/108, 75%, p < 0.001). CNRs were 75.9 ± 62.6 (mean ± standard deviation) for wall/lumen and 22.0 ± 17.1 for wall/water using SBB and 26.4 ± 15.3 and 101.6 ± 62.5 using conventional. Clinical study demonstrated (i) improved certainty and conspicuity of the vessels using SBB versus conventional (certainty, median score 3 versus 0; conspicuity, median score 3 versus 1 (p < 0.001)), (ii) improved sensitivity/specificity/accuracy of plaque (≥ 1.0 mm) detectability (0.944/0.981/0.962 versus 0.239/0.743/0.495) (p < 0.001), (iii) higher wall/lumen CNR of SBB of (78.3 ± 50.4/79.3 ± 96.7) versus hrMRI (18.9 ± 8.4/24.1 ± 14.1) (p < 0.001), and (iv) excellent reproducibility of remodeling index, plaque burden, and eccentricity using SBB versus hrMRI (intraclass correlation coefficient 0.85-0.94).<h4>Conclusions</h4>SBB can enhance the detectability of intracranial plaques with an accuracy similar to that of hrMRI.<h4>Relevance statement</h4>This new spectral black-blood technique for the detection and characterization of intracranial vessel atherosclerotic disease could be a time-saving and cost-effective diagnostic step for clinical stroke patients. It may also facilitate prevention strategies for atherosclerosis.<h4>Key points</h4>• Blooming artifacts can blur vessel wall morphology on conventional CT angiography. • Spectral black-blood (SBB) images are generated from material decomposition from spectral CT. • SBB images reduce blooming artifacts and noise and accurately detect small plaques.European radiology experimentalDetectability of intracranial vessel wall atherosclerosis using black-blood spectral CT: a phantom and clinical study.PMC11219652823RC5182021GXYL46USYZD22-09ZDYF2024SHFZ055Zhang FXiong JWu JZheng YLi JChen KYang LLangzam EMeng Qvan der Geest RJLuo CMeng XZhang TCui FYao HDeng WfalseDetectability of intracranial vessel wall atherosclerosis using black-blood spectral CT: a phantom and clinical study.<h4>Background</h4>Computed tomography (CT) is the usual modality for diagnosing stroke, but conventional CT angiography reconstructions have limitations.<h4>Methods</h4>A phantom with tubes of known diameters and wall thickness was scanned for wall detectability, wall thickness, and contrast-to-noise ratio (CNR) on conventional and spectral black-blood (SBB) images. The clinical study included 34 stroke patients. Diagnostic certainty and conspicuity of normal/abnormal intracranial vessels using SBB were compared to conventional. Sensitivity/specificity/accuracy of SBB and conventional were compared for plaque detectability. CNR of the wall/lumen and quantitative comparison of remodeling index, plaque burden, and eccentricity were obtained for SBB imaging and high-resolution magnetic resonance imaging (hrMRI).<h4>Results</h4>The phantom study showed improved detectability of tube walls using SBB (108/108, 100% versus conventional 81/108, 75%, p < 0.001). CNRs were 75.9 ± 62.6 (mean ± standard deviation) for wall/lumen and 22.0 ± 17.1 for wall/water using SBB and 26.4 ± 15.3 and 101.6 ± 62.5 using conventional. Clinical study demonstrated (i) improved certainty and conspicuity of the vessels using SBB versus conventional (certainty, median score 3 versus 0; conspicuity, median score 3 versus 1 (p < 0.001)), (ii) improved sensitivity/specificity/accuracy of plaque (≥ 1.0 mm) detectability (0.944/0.981/0.962 versus 0.239/0.743/0.495) (p < 0.001), (iii) higher wall/lumen CNR of SBB of (78.3 ± 50.4/79.3 ± 96.7) versus hrMRI (18.9 ± 8.4/24.1 ± 14.1) (p < 0.001), and (iv) excellent reproducibility of remodeling index, plaque burden, and eccentricity using SBB versus hrMRI (intraclass correlation coefficient 0.85-0.94).<h4>Conclusions</h4>SBB can enhance the detectability of intracranial plaques with an accuracy similar to that of hrMRI.<h4>Relevance statement</h4>This new spectral black-blood technique for the detection and characterization of intracranial vessel atherosclerotic disease could be a time-saving and cost-effective diagnostic step for clinical stroke patients. It may also facilitate prevention strategies for atherosclerosis.<h4>Key points</h4>• Blooming artifacts can blur vessel wall morphology on conventional CT angiography. • Spectral black-blood (SBB) images are generated from material decomposition from spectral CT. • SBB images reduce blooming artifacts and noise and accurately detect small plaques.2024-01-01T00:00:00Z2024 Jul2025-04-22T12:06:22.535Z2025-04-06T00:12:21.623ZS-EPMC112196523895595110.1186/s41747-024-00473-x