{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T02:53:40Z","timestamp":1787972020869,"version":"build-2784847793"},"reference-count":47,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T00:00:00Z","timestamp":1778630400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T00:00:00Z","timestamp":1778630400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur Radiol Exp"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Spectral computed tomography (CT) enables material decomposition and monoenergetic imaging, improving infarct-estimation on non-contrast cerebral CT (NCCT). However, beyond NCCT, infarct estimation is also accessible from CT angiography (CTA). We evaluated the potential of spectral CTA to assess quantitative differences of infarcted parenchyma in patients with stroke.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>In 14 patients with acute middle cerebral artery stroke, the ten Alberta stroke program early computed tomography score (ASPECTS) regions of the affected and non-affected sides were segmented on NCCT, CTA, CT perfusion-derived cerebral blood flow (CBF) map, and CTA-based spectral maps: virtual-non-contrast, virtual-monoenergetic 40-keV and 100-keV, iodine-density and electron-density. For each region, a ratio to the corresponding contralateral region was calculated. Classification into infarcted and non-infarcted was based on post-thrombectomy follow-up NCCT. On patient-level the groups were summarised with mean ratio-values for infarcted and non-infarcted parenchyma per patient. Conventional images and spectral maps were compared to differentiate the groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Except for NCCT, electron-density and virtual-non-contrast maps, there was a significant difference between the ratio-values of infarcted and non-infarcted regions in each spectral map, as well as in CTA and CBF (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Best differentiation was possible with iodine-density (area under the receiving operating characteristic curve [AUROC]\u2009= 1.000) and virtual-monoenergetic 40-keV (AUROC\u2009=\u20090.985) maps compared to NCCT, CTA, CBF, electron-density, and VNC maps (AUROC\u2009=\u20090.765\u20120.938).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Spectral CTA maps, like virtual-monoenergetic 40-keV and iodine-density, enabled valid quantitative ASPECTS-based infarct-estimation in stroke compared to conventional NCCT, CTA, and CBF. They harbour potential for improving stroke imaging diagnostics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Relevance statement<\/jats:title>\n                    <jats:p>Quantitative values derived from ASPECTS regions in spectral CTA maps improve differentiation of infarcted and non-infarcted regions compared to conventional images. This technique, therefore, represents an interesting approach to improve diagnostic accuracy in stroke and could potentially assist in making treatment decisions for patients with acute stroke.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key Points<\/jats:title>\n                    <jats:p>\n                      <jats:list list-type=\"bullet\">\n                        <jats:list-item>\n                          <jats:p>In patients with acute stroke, spectral CT improves infarct estimation by NCCT, while its benefit with CTA remains unclear.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Quantitative parameters derived from ASPECTS-labelled region of interest were compared between spectral CTA maps and conventional NCCT, CTA, and CBF.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>\n                            Quantitative parameters from virtual-monoenergetic 40-keV and iodine-density maps reliably differentiate infarcted\n                            <jats:italic>versus<\/jats:italic>\n                            non-infarcted ASPECTS regions compared to conventional images.\n                          <\/jats:p>\n                        <\/jats:list-item>\n                      <\/jats:list>\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Graphical Abstract<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1186\/s41747-026-00733-y","type":"journal-article","created":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T09:33:37Z","timestamp":1778664817000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Spectral CTA-based quantitative differentiation of infarcted and non-infarcted ASPECTS regions in acute stroke"],"prefix":"10.1186","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0822-9075","authenticated-orcid":false,"given":"Schekeb","family":"Aludin","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Agreen","family":"Horr","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Langguth","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tristan","family":"Klintz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Svea","family":"Seehafer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Gless","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karim","family":"Mostafa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olav","family":"Jansen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naomi","family":"Larsen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars-Patrick","family":"Schmill","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,13]]},"reference":[{"key":"733_CR1","doi-asserted-by":"publisher","first-page":"132","DOI":"10.1177\/17474930241308142","volume":"20","author":"VL Feigin","year":"2025","unstructured":"Feigin VL, Brainin M, Norrving B et al (2025) World Stroke Organization: global stroke fact sheet 2025. Int J Stroke 20:132\u2013144. https:\/\/doi.org\/10.1177\/17474930241308142","journal-title":"Int J Stroke"},{"key":"733_CR2","doi-asserted-by":"publisher","first-page":"973","DOI":"10.1016\/S1474-4422(24)00369-7","volume":"23","author":"GBD 2021 Stroke Risk Factor Collaborators","year":"2024","unstructured":"GBD 2021 Stroke Risk Factor Collaborators (2024) Global, regional, and national burden of stroke and its risk factors, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet Neurol 23:973\u20131003. https:\/\/doi.org\/10.1016\/S1474-4422(24)00369-7","journal-title":"Lancet Neurol"},{"key":"733_CR3","doi-asserted-by":"publisher","first-page":"e344","DOI":"10.1161\/STR.0000000000000211","volume":"50","author":"WJ Powers","year":"2019","unstructured":"Powers WJ, Rabinstein AA, Ackerson T et al (2019) Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association\/American Stroke Association. Stroke 50:e344\u2013e418. https:\/\/doi.org\/10.1161\/STR.0000000000000211","journal-title":"Stroke"},{"key":"733_CR4","doi-asserted-by":"publisher","first-page":"304","DOI":"10.1136\/practneurol-2020-002557","volume":"20","author":"R Hurford","year":"2020","unstructured":"Hurford R, Sekhar A, Hughes TAT et al (2020) Diagnosis and management of acute ischaemic stroke. Pract Neurol 20:304\u2013316. https:\/\/doi.org\/10.1136\/practneurol-2020-002557","journal-title":"Pract Neurol"},{"key":"733_CR5","doi-asserted-by":"publisher","first-page":"55","DOI":"10.5853\/jos.2022.03286","volume":"25","author":"M Abdalkader","year":"2023","unstructured":"Abdalkader M, Siegler JE, Lee JS et al (2023) Neuroimaging of acute ischemic stroke: multimodal imaging approach for acute endovascular therapy. J Stroke 25:55\u201371. https:\/\/doi.org\/10.5853\/jos.2022.03286","journal-title":"J Stroke"},{"key":"733_CR6","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1016\/j.ncl.2019.09.004","volume":"38","author":"AP Jadhav","year":"2020","unstructured":"Jadhav AP, Desai SM, Liebeskind DS et al (2020) Neuroimaging of acute stroke. Neurol Clin 38:185\u2013199. https:\/\/doi.org\/10.1016\/j.ncl.2019.09.004","journal-title":"Neurol Clin"},{"key":"733_CR7","doi-asserted-by":"publisher","DOI":"10.1259\/bjr.20170573","volume":"91","author":"AG Smith","year":"2018","unstructured":"Smith AG, Rowland Hill C (2018) Imaging assessment of acute ischaemic stroke: a review of radiological methods. Br J Radiol 91:20170573. https:\/\/doi.org\/10.1259\/bjr.20170573","journal-title":"Br J Radiol"},{"key":"733_CR8","doi-asserted-by":"publisher","first-page":"1670","DOI":"10.1016\/s0140-6736(00)02237-6","volume":"355","author":"PA Barber","year":"2000","unstructured":"Barber PA, Demchuk AM, Zhang J et al (2000) Validity and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy. Lancet 355:1670\u20131674. https:\/\/doi.org\/10.1016\/s0140-6736(00)02237-6","journal-title":"Lancet"},{"key":"733_CR9","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1097\/RMR.0000000000000122","volume":"26","author":"S Prakkamakul","year":"2017","unstructured":"Prakkamakul S, Yoo AJ (2017) ASPECTS CT in acute ischemia: review of current data. Top Magn Reson Imaging 26:103\u2013112. https:\/\/doi.org\/10.1097\/RMR.0000000000000122","journal-title":"Top Magn Reson Imaging"},{"key":"733_CR10","doi-asserted-by":"publisher","first-page":"2472","DOI":"10.1161\/01.STR.0000145330.14928.2a","volume":"35","author":"SB Coutts","year":"2004","unstructured":"Coutts SB, Lev MH, Eliasziw M et al (2004) ASPECTS on CTA source images versus unenhanced CT: added value in predicting final infarct extent and clinical outcome. Stroke 35:2472\u20132476. https:\/\/doi.org\/10.1161\/01.STR.0000145330.14928.2a","journal-title":"Stroke"},{"key":"733_CR11","doi-asserted-by":"publisher","first-page":"959","DOI":"10.1161\/hs0402.105388","volume":"33","author":"MA Ezzeddine","year":"2002","unstructured":"Ezzeddine MA, Lev MH, McDonald CT et al (2002) CT angiography with whole brain perfused blood volume imaging: added clinical value in the assessment of acute stroke. Stroke 33:959\u2013966. https:\/\/doi.org\/10.1161\/hs0402.105388","journal-title":"Stroke"},{"key":"733_CR12","doi-asserted-by":"publisher","first-page":"1575","DOI":"10.1161\/STROKEAHA.110.603936","volume":"42","author":"R Bhatia","year":"2011","unstructured":"Bhatia R, Bal SS, Shobha N et al (2011) CT angiographic source images predict outcome and final infarct volume better than noncontrast CT in proximal vascular occlusions. Stroke 42:1575\u20131580. https:\/\/doi.org\/10.1161\/STROKEAHA.110.603936","journal-title":"Stroke"},{"key":"733_CR13","doi-asserted-by":"publisher","first-page":"1569","DOI":"10.3174\/ajnr.A5264","volume":"38","author":"F Sallustio","year":"2017","unstructured":"Sallustio F, Motta C, Pizzuto S et al (2017) CT angiography ASPECTS predicts outcome much better than noncontrast CT in patients with stroke treated endovascularly. AJNR Am J Neuroradiol 38:1569\u20131573. https:\/\/doi.org\/10.3174\/ajnr.A5264","journal-title":"AJNR Am J Neuroradiol"},{"key":"733_CR14","doi-asserted-by":"publisher","first-page":"558","DOI":"10.1161\/STROKEAHA.122.041241","volume":"54","author":"A Alzahrani","year":"2023","unstructured":"Alzahrani A, Zhang X, Albukhari A et al (2023) Assessing brain tissue viability on nonenhanced computed tomography after ischemic stroke. Stroke 54:558\u2013566. https:\/\/doi.org\/10.1161\/STROKEAHA.122.041241","journal-title":"Stroke"},{"key":"733_CR15","doi-asserted-by":"publisher","first-page":"1574","DOI":"10.1161\/STROKEAHA.117.016745","volume":"48","author":"M Mokin","year":"2017","unstructured":"Mokin M, Primiani CT, Siddiqui AH et al (2017) ASPECTS (Alberta Stroke Program Early CT Score) measurement using Hounsfield unit values when selecting patients for stroke thrombectomy. Stroke 48:1574\u20131579. https:\/\/doi.org\/10.1161\/STROKEAHA.117.016745","journal-title":"Stroke"},{"key":"733_CR16","doi-asserted-by":"publisher","first-page":"451","DOI":"10.1148\/radiol.2019182041","volume":"291","author":"P Reidler","year":"2019","unstructured":"Reidler P, Thierfelder KM, Rotkopf LT et al (2019) Attenuation changes in ASPECTS regions: a surrogate for CT perfusion-based ischemic core in acute ischemic stroke. Radiology 291:451\u2013458. https:\/\/doi.org\/10.1148\/radiol.2019182041","journal-title":"Radiology"},{"key":"733_CR17","doi-asserted-by":"publisher","first-page":"757","DOI":"10.1590\/0004-282X20200072","volume":"78","author":"LA Ferreti","year":"2020","unstructured":"Ferreti LA, Leitao CA, Teixeira BCdA et al (2020) The use of e-ASPECTS in acute stroke care: Validation of method performance compared to the performance of specialists. Arq Neuropsiquiatr 78:757\u2013761. https:\/\/doi.org\/10.1590\/0004-282X20200072","journal-title":"Arq Neuropsiquiatr"},{"key":"733_CR18","doi-asserted-by":"publisher","first-page":"615","DOI":"10.1177\/1747493016681020","volume":"12","author":"S Nagel","year":"2017","unstructured":"Nagel S, Sinha D, Day D et al (2017) e-ASPECTS software is non-inferior to neuroradiologists in applying the ASPECT score to computed tomography scans of acute ischemic stroke patients. Int J Stroke 12:615\u2013622. https:\/\/doi.org\/10.1177\/1747493016681020","journal-title":"Int J Stroke"},{"key":"733_CR19","doi-asserted-by":"publisher","first-page":"328","DOI":"10.1177\/02841851221075789","volume":"64","author":"X Li","year":"2023","unstructured":"Li X, Zhen Y, Liu H et al (2023) Automated ASPECTS in acute ischemic stroke: comparison of the overall scores and Hounsfield unit values of two software packages and radiologists with different levels of experience. Acta Radiol 64:328\u2013335. https:\/\/doi.org\/10.1177\/02841851221075789","journal-title":"Acta Radiol"},{"key":"733_CR20","doi-asserted-by":"publisher","first-page":"e0236956","DOI":"10.1371\/journal.pone.0236956","volume":"15","author":"P Reidler","year":"2020","unstructured":"Reidler P, Puhr-Westerheide D, Rotkopf L et al (2020) Cerebral attenuation on single-phase CT angiography source images: automated ischemia detection and morphologic outcome prediction after thrombectomy in patients with ischemic stroke. PLoS One 15:e0236956. https:\/\/doi.org\/10.1371\/journal.pone.0236956","journal-title":"PLoS One"},{"key":"733_CR21","doi-asserted-by":"publisher","first-page":"763","DOI":"10.1007\/s00062-020-00956-5","volume":"31","author":"P Reidler","year":"2021","unstructured":"Reidler P, Stueckelschweiger L, Puhr-Westerheide D et al (2021) Performance of automated attenuation measurements at identifying large vessel occlusion stroke on CT angiography. Clin Neuroradiol 31:763\u2013772. https:\/\/doi.org\/10.1007\/s00062-020-00956-5","journal-title":"Clin Neuroradiol"},{"key":"733_CR22","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1016\/j.diii.2022.11.003","volume":"104","author":"J Greffier","year":"2023","unstructured":"Greffier J, Villani N, Defez D et al (2023) Spectral CT imaging: technical principles of dual-energy CT and multi-energy photon-counting CT. Diagn Interv Imaging 104:167\u2013177. https:\/\/doi.org\/10.1016\/j.diii.2022.11.003","journal-title":"Diagn Interv Imaging"},{"key":"733_CR23","doi-asserted-by":"publisher","first-page":"86","DOI":"10.3348\/kjr.2020.0144","volume":"22","author":"A So","year":"2021","unstructured":"So A, Nicolaou S (2021) Spectral computed tomography: fundamental principles and recent developments. Korean J Radiol 22:86\u201396. https:\/\/doi.org\/10.3348\/kjr.2020.0144","journal-title":"Korean J Radiol"},{"key":"733_CR24","doi-asserted-by":"publisher","first-page":"4534","DOI":"10.1007\/s00330-018-5449-4","volume":"28","author":"AE Grams","year":"2018","unstructured":"Grams AE, Djurdjevic T, Rehwald R et al (2018) Improved visualisation of early cerebral infarctions after endovascular stroke therapy using dual-energy computed tomography oedema maps. Eur Radiol 28:4534\u20134541. https:\/\/doi.org\/10.1007\/s00330-018-5449-4","journal-title":"Eur Radiol"},{"key":"733_CR25","doi-asserted-by":"publisher","first-page":"4138","DOI":"10.1007\/s00330-020-07543-9","volume":"31","author":"S Mangesius","year":"2021","unstructured":"Mangesius S, Janjic T, Steiger R et al (2021) Dual-energy computed tomography in acute ischemic stroke: state-of-the-art. Eur Radiol 31:4138\u20134147. https:\/\/doi.org\/10.1007\/s00330-020-07543-9","journal-title":"Eur Radiol"},{"key":"733_CR26","doi-asserted-by":"publisher","first-page":"1631","DOI":"10.1177\/02841851221130612","volume":"64","author":"H Mellander","year":"2023","unstructured":"Mellander H, Bengtsson P, Fransson V et al (2023) Virtual monoenergetic images by spectral detector computed tomography may improve image quality and diagnostic ability for ischemic lesions in acute ischemic stroke. Acta Radiol 64:1631\u20131640. https:\/\/doi.org\/10.1177\/02841851221130612","journal-title":"Acta Radiol"},{"key":"733_CR27","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1097\/RLI.0000000000000413","volume":"53","author":"MF Mohammed","year":"2018","unstructured":"Mohammed MF, Marais O, Min A et al (2018) Unenhanced dual-energy computed tomography: visualization of brain edema. Invest Radiol 53:63\u201369. https:\/\/doi.org\/10.1097\/RLI.0000000000000413","journal-title":"Invest Radiol"},{"key":"733_CR28","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1016\/j.jstrokecerebrovasdis.2016.08.025","volume":"26","author":"K Noguchi","year":"2017","unstructured":"Noguchi K, Itoh T, Naruto N et al (2017) A novel imaging technique (X-map) to identify acute ischemic lesions using noncontrast dual-energy computed tomography. J Stroke Cerebrovasc Dis 26:34\u201341. https:\/\/doi.org\/10.1016\/j.jstrokecerebrovasdis.2016.08.025","journal-title":"J Stroke Cerebrovasc Dis"},{"key":"733_CR29","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1007\/s00234-020-02492-y","volume":"63","author":"F van Ommen","year":"2021","unstructured":"van Ommen F, Dankbaar JW, Zhu G et al (2021) Virtual monochromatic dual-energy CT reconstructions improve detection of cerebral infarct in patients with suspicion of stroke. Neuroradiology 63:41\u201349. https:\/\/doi.org\/10.1007\/s00234-020-02492-y","journal-title":"Neuroradiology"},{"key":"733_CR30","doi-asserted-by":"publisher","first-page":"547","DOI":"10.1007\/s11604-021-01233-2","volume":"40","author":"F Tatsugami","year":"2022","unstructured":"Tatsugami F, Higaki T, Nakamura Y et al (2022) Dual-energy CT: minimal essentials for radiologists. Jpn J Radiol 40:547\u2013559. https:\/\/doi.org\/10.1007\/s11604-021-01233-2","journal-title":"Jpn J Radiol"},{"key":"733_CR31","doi-asserted-by":"publisher","unstructured":"Gu Y, Shi D, Shen H et al (2023) Nomogram based on dual-layer spectral detector CTA parameter for the prediction of infarct core in patients with acute ischemic stroke. Diagnostics (Basel). https:\/\/doi.org\/10.3390\/diagnostics13223434","DOI":"10.3390\/diagnostics13223434"},{"key":"733_CR32","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2023.1056941","volume":"14","author":"J Huang","year":"2023","unstructured":"Huang J, Chen J, Wang X et al (2023) The diagnostic value of quantitative parameters on dual-layer detector-based spectral CT in identifying ischaemic stroke. Front Neurol 14:1056941. https:\/\/doi.org\/10.3389\/fneur.2023.1056941","journal-title":"Front Neurol"},{"key":"733_CR33","doi-asserted-by":"publisher","first-page":"3435","DOI":"10.1161\/STROKEAHA.111.618355","volume":"42","author":"BCV Campbell","year":"2011","unstructured":"Campbell BCV, Christensen S, Levi CR et al (2011) Cerebral blood flow is the optimal CT perfusion parameter for assessing infarct core. Stroke 42:3435\u20133440. https:\/\/doi.org\/10.1161\/STROKEAHA.111.618355","journal-title":"Stroke"},{"key":"733_CR34","doi-asserted-by":"publisher","first-page":"1017","DOI":"10.1161\/STROKEAHA.119.028337","volume":"51","author":"J Demeestere","year":"2020","unstructured":"Demeestere J, Wouters A, Christensen S et al (2020) Review of perfusion imaging in acute ischemic stroke: from time to tissue. Stroke 51:1017\u20131024. https:\/\/doi.org\/10.1161\/STROKEAHA.119.028337","journal-title":"Stroke"},{"key":"733_CR35","doi-asserted-by":"publisher","first-page":"337","DOI":"10.1177\/19714009211047449","volume":"35","author":"D Dodig","year":"2022","unstructured":"Dodig D, Matana Ka\u0161telan Z, Bartolovi\u0107 N et al (2022) Virtual monoenergetic dual-energy CT reconstructions at 80 keV are optimal non-contrast CT technique for early stroke detection. Neuroradiol J 35:337\u2013345. https:\/\/doi.org\/10.1177\/19714009211047449","journal-title":"Neuroradiol J"},{"key":"733_CR36","doi-asserted-by":"publisher","first-page":"695","DOI":"10.1007\/s00234-020-02563-0","volume":"63","author":"S Hopf-Jensen","year":"2021","unstructured":"Hopf-Jensen S, Anraths M, Lehrke S et al (2021) Early prediction of final infarct volume with material decomposition images of dual-energy CT after mechanical thrombectomy. Neuroradiology 63:695\u2013704. https:\/\/doi.org\/10.1007\/s00234-020-02563-0","journal-title":"Neuroradiology"},{"key":"733_CR37","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1016\/j.neurad.2020.12.002","volume":"48","author":"F St\u00e5hl","year":"2021","unstructured":"St\u00e5hl F, Gontu V, Almqvist H et al (2021) Performance of dual layer dual energy CT virtual monoenergetic images to identify early ischemic changes in patients with anterior circulation large vessel occlusion. J Neuroradiol 48:75\u201381. https:\/\/doi.org\/10.1016\/j.neurad.2020.12.002","journal-title":"J Neuroradiol"},{"key":"733_CR38","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-021-85143-3","volume":"11","author":"DN Wolman","year":"2021","unstructured":"Wolman DN, van Ommen F, Tong E et al (2021) Non-contrast dual-energy CT virtual ischemia maps accurately estimate ischemic core size in large-vessel occlusive stroke. Sci Rep 11:6745. https:\/\/doi.org\/10.1038\/s41598-021-85143-3","journal-title":"Sci Rep"},{"key":"733_CR39","doi-asserted-by":"publisher","first-page":"253","DOI":"10.1177\/0846537120904347","volume":"71","author":"B Gibney","year":"2020","unstructured":"Gibney B, Redmond CE, Byrne D et al (2020) A review of the applications of dual-energy CT in acute neuroimaging. Can Assoc Radiol J 71:253\u2013265. https:\/\/doi.org\/10.1177\/0846537120904347","journal-title":"Can Assoc Radiol J"},{"key":"733_CR40","doi-asserted-by":"publisher","first-page":"1102","DOI":"10.1007\/s00330-017-5081-8","volume":"28","author":"V Neuhaus","year":"2018","unstructured":"Neuhaus V, Gro\u00dfe Hokamp N, Abdullayev N et al (2018) Comparison of virtual monoenergetic and polyenergetic images reconstructed from dual-layer detector CT angiography of the head and neck. Eur Radiol 28:1102\u20131110. https:\/\/doi.org\/10.1007\/s00330-017-5081-8","journal-title":"Eur Radiol"},{"key":"733_CR41","doi-asserted-by":"publisher","unstructured":"Herpe G, Platon A, Poletti P-A et al (2024) Dual-energy CT in acute stroke: Could non-contrast CT be replaced by virtual non-contrast CT? A feasibility study. J Clin Med. https:\/\/doi.org\/10.3390\/jcm13133647","DOI":"10.3390\/jcm13133647"},{"key":"733_CR42","doi-asserted-by":"publisher","first-page":"1259","DOI":"10.3174\/ajnr.A7600","volume":"43","author":"F Kauw","year":"2022","unstructured":"Kauw F, Ding VY, Dankbaar JW et al (2022) Detection of early ischemic changes with virtual noncontrast dual-energy CT in acute ischemic stroke: a noninferiority analysis. AJNR Am J Neuroradiol 43:1259\u20131264. https:\/\/doi.org\/10.3174\/ajnr.A7600","journal-title":"AJNR Am J Neuroradiol"},{"key":"733_CR43","doi-asserted-by":"publisher","first-page":"483","DOI":"10.1007\/s00234-021-02773-0","volume":"64","author":"M van den Broek","year":"2022","unstructured":"van den Broek M, Byrne D, Lyndon D et al (2022) ASPECTS estimation using dual-energy CTA-derived virtual non-contrast in large vessel occlusion acute ischemic stroke: A dose reduction opportunity for patients undergoing repeat CT?. Neuroradiology 64:483\u2013491. https:\/\/doi.org\/10.1007\/s00234-021-02773-0","journal-title":"Neuroradiology"},{"key":"733_CR44","doi-asserted-by":"publisher","first-page":"195","DOI":"10.3390\/tomography9010017","volume":"9","author":"AP Borges","year":"2023","unstructured":"Borges AP, Antunes C, Curvo-Semedo L (2023) Pros and cons of dual-energy CT systems: \u201cone does not fit all. Tomography 9:195\u2013216. https:\/\/doi.org\/10.3390\/tomography9010017","journal-title":"Tomography"},{"key":"733_CR45","doi-asserted-by":"publisher","DOI":"10.3389\/fmedt.2022.748949","volume":"4","author":"S Patil","year":"2022","unstructured":"Patil S, Rossi R, Jabrah D et al (2022) Detection, diagnosis and treatment of acute ischemic stroke: current and future perspectives. Front Med Technol 4:748949. https:\/\/doi.org\/10.3389\/fmedt.2022.748949","journal-title":"Front Med Technol"},{"key":"733_CR46","doi-asserted-by":"publisher","first-page":"1231","DOI":"10.1007\/s00234-020-02439-3","volume":"62","author":"P Hoelter","year":"2020","unstructured":"Hoelter P, Muehlen I, Goelitz P et al (2020) Automated ASPECT scoring in acute ischemic stroke: comparison of three software tools. Neuroradiology 62:1231\u20131238. https:\/\/doi.org\/10.1007\/s00234-020-02439-3","journal-title":"Neuroradiology"},{"key":"733_CR47","doi-asserted-by":"publisher","DOI":"10.3389\/fnins.2022.933753","volume":"16","author":"J Li","year":"2022","unstructured":"Li J, Peng Y, Liu J et al (2022) Estimation of ischemic core in acute ischemic stroke with CT angiography and non-contrast CT: attenuation changes in ASPECTS regions vs. automated ASPECTS scoring. Front Neurosci 16:933753. https:\/\/doi.org\/10.3389\/fnins.2022.933753","journal-title":"Front Neurosci"}],"container-title":["European Radiology Experimental"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s41747-026-00733-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s41747-026-00733-y","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s41747-026-00733-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T09:33:40Z","timestamp":1778664820000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s41747-026-00733-y"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,13]]},"references-count":47,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["733"],"URL":"https:\/\/doi.org\/10.1186\/s41747-026-00733-y","relation":{},"ISSN":["2509-9280"],"issn-type":[{"value":"2509-9280","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,13]]},"assertion":[{"value":"3 August 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 March 2026","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 April 2026","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 May 2026","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The research involved in this study was conducted in accordance with relevant guidelines and regulations, and the Declaration of Helsinki. Local IRB approval was obtained (approval no. D567\/18 from 15.11.2018 and its additional amendment from 29.11.2022).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Informed consent was available from all patients.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"SA, PL, and NL received speakers\u2019 honoraria from PHILIPS Healthcare. The other authors report no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"64"}}