# Photon counting CT vs. flat-panel CT in the evaluation of enhancement patterns in chronic subdural hematoma after middle meningeal artery embolization

## TL;DR

This study compares two CT techniques for evaluating chronic subdural hematoma after a specific treatment, finding that photon-counting CT provides better diagnostic confidence and identifies risk patterns.

## Contribution

The study introduces the use of photon-counting CT for improved post-embolization imaging and identifies specific enhancement patterns as potential biomarkers.

## Key findings

- PCCT showed higher diagnostic confidence and interrater reliability compared to flat-panel CT.
- Internal enhancement and fluid–fluid levels were linked to hematoma persistence or recurrence.
- PCCT improves the assessment of chronic subdural hematoma after embolization.

## Abstract

Middle meningeal artery embolization is a treatment option for chronic subdural hematoma (cSDH), but data on post-procedural imaging interpretation remain limited. This study investigates whether specific enhancement patterns can predict radiological outcomes and evaluates the utility of photon-counting computed tomography (PCCT) in distinguishing contrast enhancement from hemorrhage.

We retrospectively analyzed 105 cSDHs imaged with either PCCT or flat-panel CT immediately after embolization. Two independent raters assessed enhancement patterns; diagnostic confidence and interrater agreement were evaluated.

PCCT demonstrated higher diagnostic confidence and interrater reliability than flat-panel CT. Internal enhancement and fluid–fluid levels were significantly associated with hematoma persistence or recurrence.

PCCT enhances post-embolization imaging assessment in cSDH. Specific enhancement patterns may serve as imaging biomarkers to identify patients at increased risk for unfavorable radiological outcomes.