Photon-counting CT angiography detects more head/neck aneurysms and infundibula than energy-integrating detector CTA, reclassifying uncertain lesions

PCD-CTA detected 19% more arterial outpouchings than prior EID-CTA (per-lesion concordance 57%). It reclassified 6 of 9 uncertain lesions and 4 of 24 aneurysms, potentially refining management.

• Per-patient concordance was 48% (14/29); discordance was higher in multi-lesion (78%) than single-lesion patients (40%).
• Four aneurysms, 3 infundibula, and 1 uncertain lesion were newly reported on PCD-CTA.
• PCD-CTA clarified uncertain EID-CTA findings: 2 pseudo-lesions were identified (overlapping vessels, calcification).

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