AI-Based Denoising for Neurovascular Photon-Counting CTA Improves Objective Metrics but Not Diagnostic Confidence

Post hoc AI denoising reduced noise in neurovascular photon-counting CTA (p<0.001) but did not improve subjective IQ or diagnostic confidence in 42 pts, suggesting a ceiling effect when baseline quality is already high.

• Retrospective, single-center study of 42 patients; post hoc AI denoising significantly reduced image noise (p<0.001), with largest effect in the lower neck.
• Vessel sharpness showed small but significant differences while spatial resolution (FWHM) remained stable; subjective image quality and diagnostic confidence did not improve.
• Limitations: single-center, small sample, and a ceiling effect due to high baseline quality; challenges persist in lower neck and artifact-prone regions.

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