The purpose of this study is to compare spectral segmentation, spectral radiomic, and single-energy radiomic features in the assessment of internal and common carotid artery (ICA/CCA) stenosis and prediction of surgical outcome. Our ethical committee–approved, Health Insurance Portability and Accountability Act (HIPAA)-compliant study included 85 patients (mean age, 73 ± 10 years; male : female, 56 : 29) who underwent contrast-enhanced, dual-source dual-energy CT angiography (DECTA) (Siemens Definition Flash) of the neck for assessing ICA/CCA stenosis. Patients with a prior surgical or interventional treatment of carotid stenosis were excluded. Two radiologists graded the severity of carotid stenosis on DECTA images as mild (70%) stenosis. Thin-section, low- and high-kV DICOM images from the arterial phase acquisition were processed with a dual-energy CT prototype (DTA, eXamine, Siemens Healthineers) to generate spectral segmentation and radiomic features over regions of interest along the entire length (volume) and separately at a single-section with maximum stenosis. Multiple logistic regressions and area under the receiver operating characteristic curve (AUC) were used for data analysis. Among 85 patients, 22 ICA/CCAs had normal luminal dimensions and 148 ICA/CCAs had luminal stenosis (mild stenosis: 51, moderate: 38, severe: 59). For differentiating non-severe and severe ICA/CCA stenosis, radiomic features (volume: AUC = 0.94, 95% CI 0.88-0.96; section: AUC = 0.92, 95% CI 0.86-0.93) were significantly better than spectral segmentation features (volume: AUC = 0.86, 95% CI 0.74-0.87; section: AUC = 0.68, 95% CI 0.66-0.78) (P < .001). Spectral radiomic features predicted revascularization procedure (AUC = 0.77) and the presence of ipsilateral intracranial ischemic changes (AUC = 0.76). Spectral segmentation and radiomic features from DECTA can differentiate patients with different luminal ICA/CCA stenosis grades.

Insights from 458 peer-reviewed clinical publications indicate that photon-counting CT enhances diagnostic accuracy, reader confidence, and dose efficiency in cardiac, thoracic, neurovascular, abdominal, musculoskeletal, and pediatric imaging, with additional benefits for workflow and disease management.