Significance of enhanced cerebral gray-white matter contrast at 80 kVp compared to conventional 120 kVp CT scan in the evaluation of acute stroke

We aimed to determine whether 80 kVp conventional nonenhanced head CT scans have better gray-white matter contrast than standard 120 kVp scans performed on the same patients. Thirty head CT scans acquired at 80 kVp (CT dose index [CTDI]vol 46) were compared to prior studies in the same patients performed at 120 kVp (CTDIvol 59). Signal (Hounsfield units [HU]), noise (sd HU), and contrast-to-noise ratio per dose (CNRD) were assessed in multiple cerebral gray and white matter regions of interest. A noise correction factor was used to compensate for scanning at different CTDIvol values. Average gray matter signal at 80 kVp and 120 kVP was 33.9 ± 3.5 HU and 29 ± 4.6 HU, respectively (p < 0.0001); the averages for white matter were 22.5 ± 3.1 HU and 21.6 ± 4.6 HU, respectively (p = 0.11). Corrected noise was 3 ± 0.6 and 2.7 ± 0.6, respectively, for gray matter (p = 0.0001), and 2.8 ± 0.6 and 2.6 ± 0.5, respectively, for white matter (p = 0.00001). The gray-white matter CNRD was 4.0 ± 1.2 at 80 kVp and 2.8 ± 1 at 120 kVp (p < 0.00001). Cerebral gray-white matter CNRD is increased by 40% at 80 kVp compared to conventional 120 kVp CT scans. These findings justify further clinical evaluation in the acute stroke setting.