Lesion conspicuity assessment of prone 40-keV virtual monoenergetic imaging in arterial-phase photon-counting CT for breast cancer: a retrospective comparison with DCE-MRI

Arterial-phase 40-keV VMIs from prone PCD-CT demonstrated the highest lesion conspicuity and showed better detection capability than 70-keV VMI. In addition, their performance was comparable to or superior to DCE-T1WI. This finding was achieved despite trade-offs in increased noise, BPE and size underestimation. Thus, 40-keV VMI may serve as a useful complementary modality for local breast assessment and may be considered a potential alternative for lesion localization when MRI is not feasible, despite potential underestimation of lesion extent.