European Radiology

, Volume 27, Issue 7, pp 2690–2697 | Cite as

Dual-energy CT of the brain: Comparison between DECT angiography-derived virtual unenhanced images and true unenhanced images in the detection of intracranial haemorrhage

  • Matteo Bonatti
  • Fabio Lombardo
  • Giulia A. Zamboni
  • Patrizia Pernter
  • Roberto Pozzi Mucelli
  • Giampietro Bonatti



To evaluate the diagnostic performance of virtual non-contrast (VNC) images in detecting intracranial haemorrhages (ICHs).


Sixty-seven consecutive patients with and 67 without ICH who underwent unenhanced brain CT and DECT angiography were included. Two radiologists independently evaluated VNC and true non-contrast (TNC) images for ICH presence and type. Inter-observer agreement for VNC and TNC image evaluation was calculated. Sensitivity and specificity of VNC images for ICH detection were calculated using Fisher’s exact test. VNC and TNC images were compared for ICH extent (qualitatively and quantitatively) and conspicuity assessment.


On TNC images 116 different haemorrhages were detected in 67 patients. Inter-observer agreement ranged from 0.98–1.00 for TNC images and from 0.86–1.00 for VNC images. VNC sensitivity ranged from 0.90–1, according to the different ICH types, and specificity from 0.97–1. Qualitatively, ICH extent was underestimated on VNC images in 11.9% of cases. Haemorrhage volume did not show statistically significant differences between VNC and TNC images. Mean haemorrhage conspicuity was significantly lower on VNC images than on TNC images for both readers (p < 0.001).


VNC images are accurate for ICH detection. Haemorrhages are less conspicuous on VNC images and their extent may be underestimated.

Key points

VNC images represent a reproducible tool for detecting ICH.

ICH can be identified on VNC images with high sensitivity and specificity.

Intracranial haemorrhages are less conspicuous on VNC images than on TNC images.

Intracranial haemorrhages extent may be underestimated on VNC images.


Multidetector computed tomography Dual-energy, Virtual non-contrast Intracranial haemorrhage Brain Emergencies 

Abbreviations and acronyms


Computed tomography


Computed tomography angiography


Dual-energy CT


Intracranial haemorrhage


Region of interest


True non-contrast


Virtual non-contrast



The scientific guarantor of this publication is Bonatti Giampietro, MD. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors (Fabio Lombardo) has significant statistical expertise. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. This was a retrospective, case-control study, and was performed at one institution.


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Copyright information

© European Society of Radiology 2016

Authors and Affiliations

  • Matteo Bonatti
    • 1
  • Fabio Lombardo
    • 2
  • Giulia A. Zamboni
    • 2
  • Patrizia Pernter
    • 1
  • Roberto Pozzi Mucelli
    • 2
  • Giampietro Bonatti
    • 1
  1. 1.Department of RadiologyBolzano Central HospitalBolzanoItaly
  2. 2.Department of RadiologyUniversity of VeronaVeronaItaly

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