• Juil Park, Young Hun Choi, Jung-Eun Cheon, Woo Sun Kim, In-One Kim, Seong Yong Pak, and Bernhard Krauss.
• Department of Radiology, Seoul National University Children's Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 0380, South Korea.
• Pediatr Radiol. 2017 Nov 1; 47 (12): 1648-1658.

BackgroundAdvanced virtual monochromatic reconstruction from dual-energy brain CT has not been evaluated in children.ObjectiveTo determine the most effective advanced virtual monochromatic imaging energy level for maximizing pediatric brain parenchymal image quality in dual-energy unenhanced brain CT and to compare this technique with conventional monochromatic reconstruction and polychromatic scanning.Materials And MethodsUsing both conventional (Mono) and advanced monochromatic reconstruction (Mono+) techniques, we retrospectively reconstructed 13 virtual monochromatic imaging energy levels from 40 keV to 100 keV in 5-keV increments from dual-source, dual-energy unenhanced brain CT scans obtained in 23 children. We analyzed gray and white matter noise ratios, signal-to-noise ratios and contrast-to-noise ratio, and posterior fossa artifact. We chose the optimal mono-energetic levels and compared them with conventional CT.ResultsFor Mono+maximum optima were observed at 60 keV, and minimum posterior fossa artifact at 70 keV. For Mono, optima were at 65-70 keV, with minimum posterior fossa artifact at 75 keV. Mono+ was superior to Mono and to polychromatic CT for image-quality measures. Subjective analysis rated Mono+superior to other image sets.ConclusionOptimal virtual monochromatic imaging using Mono+ algorithm demonstrated better image quality for gray-white matter differentiation and reduction of the artifact in the posterior fossa.

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