Comparison of virtual monochromatic series, iodine overlay maps, and single energy CT equivalent images in head and neck cancer conspicuity

Objective: To compare lesion conspicuity amongst DECT monochromatic series (40, 45, 50 keV), and single-energy CT (SECT) equivalent images in head and neck squamous cell carcinomas (HNSCC). Methods: Two readers compared DECT images to 70 keV SECT equivalent series in 39 patients with HNSCC on lesion margin, enhancement, and overall conspicuity. Results: The 45 keV and 50 keV images were significantly better (p-values < 0.001) than the SECT equivalent in lesion enhancement, margins, and overall conspicuity for both readers. Readers mostly preferred the 50 keV monochromatic series. Conclusion: DECT can provide better lesion visualization than SECT in HNSCC.