• Mono+ combines increased attenuation with reduced image noise compared to standard DE-CTA. • Mono+ shows superior contrast-to-noise ratios at low keV compared to linearly-blended images. • Contrast-to-noise ratio in monoenergetic DE-CTA peaks at 40 keV. • Mono+ reconstructions significantly improve quantitative image quality at low keV levels.

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• Third-generation DSCT provides automated tube voltage adaptation with an increment of 10 kV. • 10 kV increment optimizes scans to the patient's neck anatomy. • TVA combined with ADMIRE significantly lower radiation dose in contrast-enhanced neck CT. • TVA in combination with ADMIRE reduces noise and increases SNR and CNR. • Image analysis quoted less noise and better diagnostic acceptability in third-generation DSCT.

• VMI+ combines increased contrast with reduced image noise. • VMI+ shows substantially less image noise than traditional VMI. • 40-keV reconstructions show highest SNR/CNR of the aortic and iliofemoral access route. • Observers overall prefer 60 keV VMI+ images. • VMI+ DECT imaging helps improve image quality for TAVR planning.

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BACKGROUND AND PURPOSE: Dose-saving techniques in neck CT cause increased image noise that can be counteracted by iterative reconstruction. Our aim was to evaluate the image quality of advanced modeled iterative reconstruction (ADMIRE) in contrast-enhanced low-tube-voltage neck CT.