Photon-counting Detector CT Research Articles

Quantitative assessment of areal bone mineral density using multi-energy localizer radiographs from photon-counting detector CT

Objective.To assess the accuracy and stability of areal bone-mineral-density (aBMD) measurements from multi-energy CT localizer radiographs acquired using photon-counting detector (PCD) CT.Approach.A European Spine Phantom (ESP) with hydroxyapatite (HA 0.5, 1.0 and 1.5 g cm-2) was scanned using clinical PCD-CT and a dual-energy x-ray absorptiometry (DXA) to compare aBMD values. To assess aBMD stability and reproducibility, PCD-localizers were acquired twice a day for one week, and once per week for five weeks. Multiple ESP anteroposterior thicknesses (18, 26, 34, and 40 cm) were achieved using a synthetic gel layer and scanned across eight tube current values for both 120 kV (15-120 mA) and 140 kV (10-80 mA). One-way analysis of variance was performed for statistical significance (p< 0.05 considered significant). Quantitative HA and water maps were reconstructed using a prototype material-decomposition software, and aBMD was calculated after background correction.In vivoperformance of PCD-based aBMD was illustrated using a patient scan acquired at 140 kV and 40 mA, and lumbar aBMD values were compared with DXA.Main results.The ESP aBMD values from PCD-localizers demonstrated excellent day-to-day stability with a coefficient-of-variation ranging from 0.42% to 0.53%, with mean absolute percentage errors (MAPE) of less than 5% for all three vertebral bodies. The coefficient-of-variation for weekly scans ranged from 0.17% to 0.60%, again with MAPE below 5% for all three vertebral bodies. Across phantom sizes and tube currents, the MAPE values varied ranging from 1.84% to 13.78% for 120 kV, and 1.38%-9.11% for 140 kV. No significant difference was found between different tube currents. For the standard phantom size, DXA showed 11.21% MAPE whereas PCD-CT showed 3.04% MAPE. For the patient scan, deviation between PCD-based aBMD values and those obtained from DXA ranged from 0.07% to 9.82% for different lumbar vertebra.Significance.This study highlights the accuracy and stability of PCD-CT localizers for measuring aBMD. We demonstrated aBMD accuracy across different sizes and showed that higher radiation doses did not inherently increase aBMD accuracy.

Photon-Counting CT Iodine Maps for Diagnosing Chronic Pulmonary Thromboembolism: A Pilot Study.

The aim of this study was to evaluate the feasibility and efficacy of chronic pulmonary thromboembolism assessment using photon-counting detector computed tomography (PCD-CT) iodine maps of the lung parenchyma. This institutional review board-approved retrospective study included 83 subjects (49.4% male, aged 62.4 ± 13.4 years; 50.6% female, aged 59.9 ± 17.1 years) who underwent clinically indicated PCD-CT scan to rule out chronic thromboembolic pulmonary hypertension (CTEPH). Two blinded readers used iodine maps and corresponding sharp-kernel CT reconstructions in the lung window to evaluate perfusion defects and identify patients with chronic pulmonary thromboembolism (CTEPH, CTEPH overlap with other causes of pulmonary hypertension [PH], chronic thromboembolic disease [CTED]). No other clinical or imaging information was given. Discordance was resolved in a subsequent consensus read. The clinical diagnosis was reviewed in an interdisciplinary clinical setting. The accuracy, sensitivity, and specificity of radiologic evaluation and clinical diagnosis were calculated. Of the 83 subjects included, 32 were diagnosed with CTEPH, CTEPH overlap, or CTED, 35 were diagnosed with PH caused by other pathologic mechanisms, 10 had no PH, and 6 had suffered previous acute pulmonary embolism, which resolved. The interreader agreement was good (Cohen κ = 0.74). The consensus reached high accuracy (0.88), sensitivity (0.94), and specificity (0.84), as well as good agreement with interdisciplinary clinical diagnosis (Cohen κ = 0.75). No cases with confirmed CTEPH as the primary cause of PH or CTED were missed. Patients with pulmonary arterial hypertension were most frequently rated false-positive. The mean effective dose (±standard deviation) was 1.3 (±0.76) mSv. Accurate, sensitive, and specific diagnosis of pulmonary chronic thromboembolism at low radiation dose is possible using iodine maps reconstructed from PCD-CT scans.

Radiomics Feature Stability in True and Virtual Non-Contrast Reconstructions from Cardiac Photon-Counting Detector CT Datasets

Radiomics Feature Stability in True and Virtual Non-Contrast Reconstructions from Cardiac Photon-Counting Detector CT Datasets

In-Stent Restenosis in Peripheral Arterial Disease: Ultra-High-Resolution Photon-Counting Versus Third-Generation Dual-Source Energy-Integrating Detector CT Phantom Study in Seven Different Stent Types.

The visualization of peripheral in-stent restenosis using energy-integrating detector CT is challenging due to deficient spatial resolution and artifact formation. This study compares the first clinically available photon-counting detector CT to third-generation dual-source energy-integrating detector CT. Nylon cylinders with central bores (4mm, 2mm), mimicking 75% and 95% stenoses, were placed inside seven different 8-mm diameter stents and filled with diluted contrast medium. Phantoms were scanned with photon-counting detector CT at slice thicknesses of 0.2mm (available only in this scanner type), 0.5mm, and 1.0mm versus 0.5mm and 1.0mm in energy-integrating detector CT at matched CT dose indices. Contrast-to-noise ratios were calculated from attenuation rates. Residual lumen size was measured as full width at half-maximum. Subjective image quality was assessed by two independent blinded raters. Mean contrast-to-noise ratio was lowest in photon-counting detector CT at 0.2mm slice thickness (0%, 75%, and 95% in-stent restenosis: 6.11 ± 0.6, 5.27 ± 0.54, and 5.02 ± 0.66) and highest at 1.0mm slice thicknesses with similar measurements in photon-counting detector CT and energy-integrating detector CT (11.46 ± 1.08, 9.94 ± 1.01, 8.26 ± 1.0 vs. 3.34 ± 1.0, 9.92 ± 0.38, 7.94 ± 1.07). Mean full width at half-maximum measurements in photon-counting detector CT at 0.2mm slice thickness for 0%, 75%, and 95% in-stent restenosis were 8.00 ± 0.37, 3.98 ± 0.34, and 1.92 ± 0.16mm. Full width at half-maximum was least precise in 95% in-stent restenosis at 1.0mm slice thickness with similar measurements between scanners (1.57 ± 0.33 vs. 1.71 ± 0.15mm). Interrater correlation coefficient was 0.75 [95% CI: [0.53; 0.86]; subjective scores were best at 0.2mm slice thickness in photon-counting detector CT (19.43 ± 0.51 and 19.00 ± 0.68). In phantom in-stent restenosis in 8mm stents, we observed similar full width at half-maximum for photon-counting detector CT and energy-integrating detector CT in 0% and 75% in-stent restenosis, but at 95% in-stent restenosis, FWHM tended to be more accurate in smaller slice thicknesses in both scanners. Subjective image assessment yielded best results at 0.2mm slice thickness in photon-counting detector CT despite lower contrast-to-noise ratio.

Opportunistic Bone Mineral Density Measurement Using Photon-Counting Detector CT Spectral Localizer Images: A Prospective Study.

Background: Spectral localizer images from photon-counting detector (PCD) CT can be used for bone mineral density (BMD) evaluation given their 2D-projectional nature and material decomposition capability. As all CT examinations include localizer images, this approach could allow opportunistic osteoporosis screening in patients undergoing clinically indicated imaging by PCD CT. Objective: To assess the utility of PCD-CT spectral localizer images for opportunistic derivation of area BMD (aBMD) values and T-scores, using dual-energy X-ray absorptiometry (DXA) as the reference standard. Methods: This prospective study included patients ≥18 years old scheduled for clinically indicated lumbar spine CT between October 2023 and February 2024 and who underwent DXA within the 13 prior months or were scheduled for DXA within the subsequent 13 months. Participants underwent lumbar spine CT by PCD CT including spectral localizer images. Lumbar spine aBMD was extracted from clinical DXA reports. ROIs were placed on lumbar vertebral bodies and background soft tissues to extract areal densities from spectral localizer images using material decomposition; areal densities were used to derive lumbar spine aBMD values. The aBMD values were used to derive T-scores, which were classified as representing normal (≥-1) or abnormal (<-1) bone mass. DXA-derived and PCD-CT derived measurements were compared. Results: The study included 51 participants (mean age: 62 years [range, 28-83 years]; 31 female, 20 male). Mean DXA-derived T-score was 0.39±1.64; mean PCD-CT derived T-score was 0.28±1.77 (p=.29). Lin's concordance correlation coefficient between DXA-derived and PCD-CT T-scores was 0.90. The difference between DXA-derived and PCD-CT derived T-scores showed a small correlation with patient age (r=-0.13), absolute interval between DXA and PCD CT (r=.15), and BMI (r=0.28); this difference in scores did not show a significant difference between male and female patients (0.08 vs 0.13, respectively; p=.81). PCD-CT T-scores had sensitivity of 97%, specificity of 71%, PPV of 90%, and NPV of 91% for detecting abnormal bone mass using DXA-derived T-scores as the reference standard. Conclusion: PCD-CT spectral localizers showed clinical utility for deriving aBMD values and, consequently, T-scores. Clinical Impact: The T-score derived from PCD-CT spectral localizers may serve as an opportunistic screening tool for low bone mass and osteoporosis.

Ultra-high-resolution photon-counting detector CT for visualization of the brachial plexus

ObjectivesTo investigate the use of photon-counting detector CT (PCD-CT) to improve brachial plexus depiction. Materials and MethodsThis retrospective study included patients who underwent neck CT from March to December 2023. To assess the optimal reconstruction condition in PCD-CT, the signal-to-noise ratios (SNRs) on images using various quantitative regular (Qr) kernels and strengths of quantum iterative reconstruction (QIR) were evaluated. Next, images obtained by ultra-high-resolution mode in PCD-CT (PCD-UHR), standard mode in PCD-CT (PCD-STD), and standard mode in energy-integrating detector CT (EID-STD) of 20 patients each were compared regarding brachial plexus depiction. A qualitative evaluation was performed using a 5-point Likert scale regarding sharpness, noise, and overall image quality. The standard deviations (SDs), SNRs, and contrast-to noise ratios (CNRs) were quantitatively evaluated. ResultsOverall, 60 patients (mean age, 63 years ± 18; 30 males) were included. The SNRs for the Qr40 and QIR4 (means ± SDs) were 3.6 ± 1.1 and 4.1 ± 1.2, respectively, significantly higher than others (P < 0.05). The scores for overall image quality were 4 [4–5], 3 [3–4], and 2 [2–3], and those for sharpness were 4 [3–5], 3 [3–3], and 2 [1–3] for PCD-UHR, PCD-STD, and EID-STD, respectively (all, P < 0.05). Those for noise were 3 [3–4], 4 [3–4], and 2 [2–2], the SDs were 6.6 ± 1.6, 5.4 ± 0.8, and 8.8 ± 1.7, SNRs were 5.0 ± 1.4, 6,1 ± 1.2, and 3.5 ± 1.6, and CNRs were 5.6 ± 1.9, 7.9 ± 1.7, and 4.4 ± 1.8, respectively (between either of the PCD groups and EID-STD, P < 0.05). ConclusionPCD-CT showed superior delineation for brachial plexus to EID-CT.

Pediatric contrast-enhanced chest CT on a photon-counting detector CT: radiation dose and image quality compared to energy-integrated detector CT.

Photon counting detector (PCD) CT benefits from reduced noise compared with conventional energy-integrating detector (EID) CT, which should translate to improved image quality and reduced radiation exposure for pediatric patients undergoing chest CT with IV contrast. To determine the differences in radiation exposure and image quality of PCD CT and EID CT in pediatric chest CT with intravenous (IV) contrast. In this institutional review board-approved retrospective observational study, 20 scan pairs (20 PCD CT; 20 EID CT) for children who underwent chest CT with IV contrast on both a PCD CT (Siemens NAEOTOM Alpha) and an EID CT (Siemens SOMATOM Definition Edge or Force) within 12months were reviewed independently by three pediatric radiologists for three subjective quality features on 5-point Likert scales: overall quality, small structure delineation, and motion artifact. Objective measures of image quality (image noise, signal-to-noise ratio, and contrast-to-noise ratio) were assessed by a single radiologist in several locations in the chest through region of interest measurement of Hounsfield units (HU) and standard deviation. Patient-related and radiation exposure parameters were collected for each scan and summarized with median and interquartile range (IQR). The Wilcoxon rank-sum test was utilized to compare groups. A P < 0.05 indicated statistical significance. Inter-observer agreement of subjective image quality metrics was analyzed using weighted kappa. Age (14.2years vs 13.8years, P= 0.15), height (P= 0.13), weight (P= 0.21), and BMI (P = 0.24) did not significantly differ between groups. There were 10 male and 3 female patients. Compared to EID CT, PCD CT showed lower radiation exposure parameters including volumetric CT dose index, 1.7mGy (IQR 1.1-2.4mGy) vs 3.8mGy (IQR 2.0-4.7mGy) (P< 0.01), and size-specific dose estimate, 2.6mGy (IQR 1.8-3.1mGy) vs 5.0mGy (IQR 3.3-6.2mGy) (P< 0.01). Objective image quality of lung parenchyma was improved on the PCD CT scanner, including image noise 119.5 HU (IQR 95.4-135.7 HU) vs 143.1 HU (IQR 125.4-169.8 HU) (P < 0.01), signal-to-noise ratio (SNR) -6.1 (IQR -8.4 to -4.8) vs -4.9 (IQR -5.6 to -3.8) (P= 0.01), and contrast-to-noise ratio -63.9 (-84.1 to -57.5) vs -60.5 (-76.3 to -52.5) (P = 0.01). Motion artifact was improved on the PCD CT scanner (P< 0.01). No significant differences in overall image quality or small structure delineation were identified (P= 0.06 and P= 0.31). PCD CT pediatric chest CT had significantly reduced radiation exposure, improved image quality, and reduced motion artifact compared with EID CT.

Ultra-High-Resolution Photon-Counting Detector CT Benefits Visualization of Abdominal Arteries: A Comparison to Standard-Reconstruction.

This study aimedto investigate the potential benefit of ultra-high-resolution (UHR) photon-counting detector CT (PCD-CT) angiography in visualization of abdominal arteries in comparison to standard-reconstruction (SR) images of virtual monoenergetic images (VMI) at low kiloelectron volt (keV).We prospectively included 47 and 47 participants to undergo contrast-enhanced abdominal CT scans within UHR mode on a PCD-CT systemusing full-dose (FD) and low-dose (LD) protocols, respectively. The data were reconstructed into six series of images: FD_UHR_Br48, FD_UHR_Bv56, FD_UHR_Bv60, FD_SR_Bv40, LD_UHR_Bv48, and LD_SR_Bv40. The UHR reconstructions were performed with three kernels (Bv48, Bv56, and Bv60) within 0.2mm. The SR were virtual monoenergetic imaging reconstruction with Bv40 kernel at 40-keV within 1mm. Each series of axial images were reconstructed into coronal and volume-rendered images. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of seven arteries were measured. Three radiologists assessed the image quality, and visibility of nine arteries on all the images.SNR and CNR values of SR images were significantly higher than those of UHR images (P < 0.001). The SR images have higher ratings in image noise (P < 0.001), but the FD_UHR_Bv56 and FD_UHR_Bv60 images has higher rating in vessel sharpness (P < 0.001). The overall quality was not significantly different among FD_VMI_40keV, LD_VMI_40keV, FD_UHR_Bv48, and LD_UHR_Bv48 images (P > 0.05) but higher than those of FD_UHR_Bv56 and FD_UHR_Bv60 images (P < 0.001). There is no significant difference of nine abdominal arteries among six series of images of axial, coronal and volume-rendered images (P > 0.05).To conclude, 1-mm SR image of VMI at 40-keV is superior to 0.2-mm UHR regardless of which kernel is used to visualize abdominal arteries, while 0.2-mm UHR image using a relatively smooth kernel may allow similar image quality and artery visibility when thinner slice image is warranted.

Impact of Photon-counting Detector Computed Tomography on a Quantitative Interstitial Lung Disease Machine Learning Model.

Compare the impact of photon-counting detector computed tomography (PCD-CT) to conventional CT on an interstitial lung disease (ILD) quantitative machine learning (QML) model. A QML model analyzed 52 CT exams from patients who underwent same-day conventional and PCD-CT for suspected ILD. Lin's concordance correlation coefficient (CCC) assessed agreement between conventional and PCD-CT QML results. A CCC >0.90 was regarded as excellent, 0.9 to 0.8 as good, and <0.80 as a poor concordance. Spearman rank correlation evaluated the association between pulmonary function test results (PFT) and QML features (reticulation [R], honeycombing [HC], ground glass [GG], interstitial lung disease [ILD], and vessel-related structures [VRS]). Correlations were statistically significant if the 95% CI did not include 0.00 and P value <0.05. Conventional and PCD-CT QML results had good to excellent concordance (CCC ≥0.8) except for total HC (CCC <0.8), likely related to better PCD-CT honeycombing delineation. Overall, compared with conventional CT, PCD-CT had consistently more statistically significant correlation with PFT for HC (9 PCD vs. 2 conventional of 28 total and regional associations), similar correlation for R (20 PCD vs. 18 conventional of 28 associations) and VRS (19 PCD vs. 23 conventional of 28 associations), and less correlation for GG extent (12 PCD vs. 20 conventional associations). There is strong agreement between conventional and PCD-CT QML ILD features except for HC. PCD-CT improved HC but decreased GG extent correlation with PFT. Therefore, even though most quantitative features were not impacted by the newer PCD-CT technology, model adjustment is necessary.

Diagnostic Performance and Clinical Impact of Photon-Counting Detector Computed Tomography in Coronary Artery Disease.

Photon-counting detector-computed tomography (PCD-CT) has emerged as a promising technology, offering improved spatial resolution. This study aimed to evaluate the clinical impact and diagnostic performance of PCD-CT vs conventional energy-integrating detector computed tomography (EID-CT) for obstructive coronary artery disease (CAD). From 2022 to 2023, we retrospectively identified 7,833 consecutive patients who underwent clinically indicated coronary computed tomography angiography (CCTA) at a single center, with either PCD-CT (n=3,876; NAEOTOM Alpha [Siemens Healthineers]) or EID-CT (n=3,957; Revolution Apex 256 [GE HealthCare] or Aquilion ONE ViSION 320 [Canon Medical Systems]) scanners. Subsequent invasive coronary angiography (ICA) and percutaneous or surgical revascularization were performed as part of routine clinical care. Among those referred for ICA after coronary CTA, the presence of obstructive CAD in each vessel was determined by coronary CTA (severe stenosis on visual assessment per the Coronary Artery Disease Reporting and Data System) and ICA (≥50% diameter stenosis on quantitative coronary angiography) in a blinded fashion. The diagnostic performance of EID-CT and PCD-CT was compared by using quantitative coronary angiography as the reference standard. Patients who underwent PCD-CT were less frequently referred to subsequent ICA than those undergoing EID-CT (9.9% vs 13.1%; P< 0.001). Among those who underwent ICA, revascularization was more frequently performed in the PCD-CT group than in the EID-CT group (43.4% vs 35.5%; P=0.02). In the vessel-level analysis (n=1,686), specificity (98.0% vs 93.0%; P< 0.001), positive predictive value (83.3% vs 63.0%; P=0.002), and diagnostic accuracy (97.2% vs 92.8%; P< 0.001) were improved by PCD-CT. Sensitivity (90.9% vs 90.7%; P=0.95) and negative predictive value (98.9% vs 98.7%; P=0.83) for obstructive CAD were similar between the PCD-CT and EID-CT groups, respectively. PCD-CT exhibited excellent diagnostic performance for detecting obstructive CAD. Compared with patients undergoing conventional EID-CT, fewer patients were referred to ICA after PCD-CT, but those referred were more likely to undergo revascularization.

First photon-counting detector computed tomography in the living crocodile: a 3D-Imaging study with special reference to amphibious hearing.

Crocodiles are semi-aquatic animals well adapted to hear both on land and under water. Currently, there is limited information on how their amphibious hearing is accomplished. Here, we describe, for the first time, the ear anatomy in the living crocodile using photon-counting detector computed tomography (PCD-CT) and 3D rendering. We speculate on how crocodiles, despite their closed ear canals, can use tympanic hearing in water that also provides directional hearing. A Cuban crocodile (Crocodylus rhombifer) underwent photon-counting detector computed tomography (PCD-CT), under anesthesia and spontaneous respiration. In addition two seven-month-old C. rhombifer and a juvenile Morelet´s crocodile (Crocodylus moreletii) underwent micro-computed tomography (µCT) and endoscopy. One adult Cuviérs dwarf caiman (Paleosuchus palpebrosus) was micro-dissected and video-recorded. Aeration, earflap, and middle ear morphology were evaluated and compared after 3D modeling. PCD-CT and µCT with 3D rendering and segmentation demonstrated the anatomy of the external and middle ears with high resolution in both living and expired crocodiles. Based on the findings and comparative examinations, we suggest that the superior earflap, by modulating the meatal recess together with local bone conduction, may implement tympanic hearing in submerged crocodiles, including directional hearing.

Ultra-high resolution CT angiography for the assessment of intracranial stents and flow diverters using photon counting detector CT

BackgroundThe patency of intracranial stents may not be reliably assessed with either CT angiography or MR angiography due to imaging artifacts. We investigated the potential of ultra-high resolution CT angiography...

Evaluating small coronary stents with dual-source photon-counting computed tomography: effect of different scan modes on image quality and performance in a phantom.

The study aimed to assess the feasibility and image quality of dual-source photon-counting detector computed tomography (PCD-CT) in evaluating small-sized coronary artery stents with respect to different acquisition modes in a phantom model. Utilizing a phantom setup mimicking the average patient's water-equivalent diameter, we examined six distinct coronary stents inflated in a silicon tube, with stent sizes ranging from 2.0 to 3.5 mm, applying four different CT acquisition modes of a dual-source PCD-CT scanner: "high-pitch," "sequential," "spiral" (each with collimation of 144 × 0.4 mm and full spectral information), and "ultra-high-resolution (UHR)" (collimation of 120 × 0.2 mm and no spectral information). Image quality and diagnostic confidence were assessed using subjective measures, including a 4-point visual grading scale (4 = excellent; 1 = non-diagnostic) utilized by two independent radiologists, and objective measures, including the full width at half maximum (FWHM). A total of 24 scans were acquired, and all were included in the analysis. Among all CT acquisition modes, the highest image quality was obtained for the UHR mode [median score: 4 (interquartile range (IQR): 3.67-4.00)] (P = 0.0015, with 37.5% rated as "excellent"), followed by the sequential mode [median score: 3.5 (IQR: 2.84-4.00)], P = 0.0326 and the spiral mode [median score: 3.0 (IQR: 2.53-3.47), P > 0.05]. The lowest image quality was observed for the high-pitch mode [median score: 2 (IQR: 1- 3), P = 0.028]. Similarly, diagnostic confidence for evaluating stent patency was highest for UHR and lowest for high-pitch (P < 0.001, respectively). Measurement of stent dimensions was accurate for all acquisition modes, with the UHR mode showing highest robustness (FWHM for sequential: 0.926 ± 0.061 vs. high-pitch: 0.990 ± 0.083 vs. spiral: 0.962 ± 0.085 vs. UHR: 0.941 ± 0.036, P = non-significant, respectively). Assessing small-sized coronary stents using PCD-CT technology is feasible. The UHR mode offers superior image quality and diagnostic confidence, while all modes show consistent and accurate measurements. These findings highlight the potential of PCD-CT technology, particularly the UHR mode, to enhance non-invasive coronary stent evaluation. Confirmatory research is necessary to influence the guidelines, which recommend cardiac CT only for stents of 3 mm or larger.

Additional Diagnostic Value of Cone Beam CT Myelography Performed After Digital Subtraction Myelography for Detecting CSF-venous Fistulas.

CSF-venous fistulas are a common cause of spontaneous intracranial hypotension. The diagnosis and precise localization of these fistulas hinges on specialized myelographic techniques, which mainly include decubitus digital subtraction myelography and decubitus CT myelography (using either energy integrating or photon counting detector CT). A previous case series showed that cone beam CT myelography, performed as an adjunctive tool with digital subtraction myelography, increased the detection of CSF-venous fistulas. Here, we sought to determine the additive yield of cone beam CT myelography for CSF-venous fistula detection in a consecutive series of patients with spontaneous intracranial hypotension who underwent concurrent decubitus digital subtraction myelography and cone beam CT myelography. We retrospectively searched our institutional database for all consecutive patients who underwent decubitus digital subtraction myelography with adjunctive cone beam CT myelography between 8/5/2021 and 8/5/2024. We excluded any patients harboring extradural CSF on spine imaging, not meeting International Classification of Headache Disorders (3rd edition) criteria for spontaneous intracranial hypotension, or not having undergone technically successful cone beam CT myelography in combination with digital subtraction myelography. All myelographic images were independently reviewed by two neuroradiologists. We calculated the diagnostic yield of both myelographic tests for localizing a CSF-venous fistula. We identified 100 patients who underwent decubitus digital subtraction myelography with adjunctive cone beam CT. We excluded 15 patients based on above criteria. 59/85 patients had a single definitive CSF-venous fistula. Among positive cases, the fistula was visible on digital subtraction myelography in 38/59 patients and visible on cone beam CT myelography in 59/59 patients. In 26/85 patients, no definitive fistula was identified on either modality. Cone beam CT myelography increased the diagnostic yield for CSF-venous fistula detection and may be a useful addition to digital subtraction myelography. CB-CTM = cone beam CT myelography; CVF = CSF-venous fistula; DSM = digital subtraction myelography; EID-CTM = energy integrating detector CT myelography; PCD CTM = photon counting detector CT myelography; SIH = spontaneous intracranial hypotension.

Photon-counting detector computed tomography : Paradigm shift in cardiac CT imaging

The introduction of photon-counting detector computed tomography (PCD-CT) heralds anew generation of cardiac imaging. This review discusses the current scientific literature to determine the incremental value of PCD-CT in cardiac imaging. Discussion of currently available literature regarding cardiac PCD-CT from aradiological perspective. Since its market introduction in 2021, numerous studies have explored the advantages of this new technology in the field of cardiac imaging, including improved image quality through superior spatial resolution, ahigher contrast-to-noise ratio, reduced artifacts, and lower radiation dose. While preliminary studies have been promising, it remains to be seen how the advantages of PCD-CT will affect clinical guidelines for cardiac CT.

Image quality of photon-counting detector CT for visualization of maxillofacial anatomy in comparison with energy-integrating detector CT and intraoperative C-arm CBCT

BackgroundAccurate diagnostic imaging is crucial for managing facial fractures, which are a common global occurrence. This study aimed to compare the image quality of Photon Counting Detector CT (PCD-CT) with state-of-the-art Energy Integrating Detector CT (EID-CT) and intraoperative C-arm CBCT (CBCT) in visualizing maxillofacial anatomy using a cadaveric sheep head model. MethodsThree fresh sheep heads were used, with surgical interventions simulating metal implants in two of them. The specimens were imaged using PCD-CT, EID-CT, and CBCT, following which quantitative assessments of signal-to-noise ratio, sharpness, and artifacts were conducted. A visual grading study was performed by six observers, using criteria focusing on the mandible, orbit, and soft tissues. Statistical analyses included Friedman tests for comparing modalities and Kendall’s W and Gwet’s AC1 for assessing inter- and intrarater agreement. ResultsPCD-CT demonstrated a significantly higher signal-to-noise ratio (p = 0.03) and bone sharpness (p < 0.001) compared to CBCT. In visual grading, PCD-CT outperformed CBCT, but not EID-CT, particularly in delineating mandibular and orbital structures. EID-CT and PCD-CT showed slightly more severe hypodense artifacts (p = 0.01) but were comparable in streak artifact presentation. The interrater and intrarater agreements indicated consistent evaluations across and within observers. ConclusionPCD-CT exhibits superior image quality over CBCT in key parameters essential for maxillofacial imaging, while no apparent improvement was shown compared to state-of-the-art EID-CT. PCD-CT offers enhanced visualization of critical anatomical structures, suggesting its potential as a preferred modality in managing maxillofacial trauma. The findings in this study align with limited existing research on PCD-CT, underscoring its promise for advanced diagnostic imaging in maxillofacial applications.

Assessment of Emphysema on X-ray Equivalent Dose Photon-Counting Detector CT

Objectives The aim of this study was to evaluate the feasibility and efficacy of visual scoring, low-attenuation volume (LAV), and deep learning methods for estimating emphysema extent in x-ray dose photon-counting detector computed tomography (PCD-CT), aiming to explore future dose reduction potentials. Methods One hundred one prospectively enrolled patients underwent noncontrast low- and chest x-ray dose CT scans in the same study using PCD-CT. Overall image quality, sharpness, and noise, as well as visual emphysema pattern (no, trace, mild, moderate, confluent, and advanced destructive emphysema; as defined by the Fleischner Society), were independently assessed by 2 experienced radiologists for low- and x-ray dose images, followed by an expert consensus read. In the second step, automated emphysema quantification was performed using an established LAV algorithm with a threshold of −950 HU and a commercially available deep learning model for automated emphysema quantification. Automated estimations of emphysema extent were converted and compared with visual scoring ratings. Results X-ray dose scans exhibited a significantly lower computed tomography dose index than low-dose scans (low-dose: 0.66 ± 0.16 mGy, x-ray dose: 0.11 ± 0.03 mGy, P &lt; 0.001). Interreader agreement between low- and x-ray dose for visual emphysema scoring was excellent (κ = 0.83). Visual emphysema scoring consensus showed good agreement between low-dose and x-ray dose scans (κ = 0.70), with significant and strong correlation (Spearman ρ = 0.79). Although trace emphysema was underestimated in x-ray dose scans, there was no significant difference in the detection of higher-grade (mild to advanced destructive) emphysema (P = 0.125) between the 2 scan doses. Although predicted emphysema volumes on x-ray dose scans for the LAV method showed strong and the deep learning model excellent significant correlations with predictions on low-dose scans, both methods significantly overestimated emphysema volumes on lower quality scans (P &lt; 0.001), with the deep learning model being more robust. Further, deep learning emphysema severity estimations showed higher agreement (κ = 0.65) and correlation (Spearman ρ = 0.64) with visual scoring for low-dose scans than LAV predictions (κ = 0.48, Spearman ρ = 0.45). Conclusions The severity of emphysema can be reliably estimated using visual scoring on CT scans performed with x-ray equivalent doses on a PCD-CT. A deep learning algorithm demonstrated good agreement and strong correlation with the visual scoring method on low-dose scans. However, both the deep learning and LAV algorithms overestimated emphysema extent on x-ray dose scans. Nonetheless, x-ray equivalent radiation dose scans may revolutionize the detection and monitoring of disease in chronic obstructive pulmonary disease patients.

Integrating Coronary Artery Assessment and Myocardial Late Enhancement Imaging With Photon-Counting Detector CT: Visualizing the Invisible.

Integrating Coronary Artery Assessment and Myocardial Late Enhancement Imaging With Photon-Counting Detector CT: Visualizing the Invisible.

Oral CT Contrast Agents: What's New and Why, From the AJR Special Series on Contrast Media.

Current CT oral contrast agents improve the conspicuity of and confidence in bowel and peritoneal findings in many clinical scenarios, particularly for outpatient and oncologic abdominopelvic imaging. Yet, existing positive and neutral oral contrast agents may diminish the detectability of certain radiologic findings, frequently in the same scans in which the oral contrast agent improves the detectability of other findings. With ongoing improvements in CT technology, particularly multienergy CT, opportunities are opening for new types of oral contrast agents to further improve anatomic delineation and disease detection using CT. The CT signal of new dark oral contrast agents and of new high-Z oral contrast agents promises to combine the strengths of both positive and neutral oral CT contrast agents by providing distinct CT appearances in comparison with bodily tissues, iodinated IV contrast agents, and other classes of new CT contrast agents. High-Z oral contrast agents will unlock previously inaccessible capabilities of multienergy CT, particularly photon-counting detector CT, for differentiating simultaneously administered IV and oral contrast agents; this technique will allow generation of rich 3D, intuitive, perfectly coregistered, high-resolution image sets with individual contrast agent "colors" that provide compelling clarity for intertwined intraabdominal anatomy and disease processes.

Improved Discriminability of Severe Lung Injury and Atelectasis in Thoracic Trauma at Low keV Virtual Monoenergetic Images from Photon-Counting Detector CT

Objectives: To evaluate the value of virtual monoenergetic images (VMI) from photon-counting detector CT (PCD-CT) for discriminability of severe lung injury and atelectasis in polytraumatized patients. Materials &amp; Methods: Contrast-enhanced PCD-CT examinations of 20 polytraumatized patients with severe thoracic trauma were included in this retrospective study. Spectral PCD-CT data were reconstructed using a noise-optimized virtual monoenergetic imaging (VMI) algorithm with calculated VMIs ranging from 40 to 120 keV at 10 keV increments. Injury-to-atelectasis contrast-to-noise ratio (CNR) was calculated and compared at each energy level based on CT number measurements in severely injured as well as atelectatic lung areas. Three radiologists assessed subjective discriminability, noise perception, and overall image quality. Results: CT values for atelectasis decreased as photon energy increased from 40 keV to 120 keV (mean Hounsfield units (HU): 69 at 40 keV; 342 at 120 keV), whereas CT values for severe lung injury remained near-constant from 40 keV to 120 keV (mean HU: 42 at 40 keV; 44 at 120 keV) with significant differences at each keV level (p &lt; 0.001). The optimal injury-to-atelectasis CNR was observed at 40 keV in comparison with the remaining energy levels (p &lt; 0.001) except for 50 keV (p &gt; 0.05). In line with this, VMIs at 40 keV were rated best regarding subjective discriminability. VMIs at 60–70 keV, however, provided the highest subjective observer parameters regarding subjective image noise as well as image quality. Conclusions: Discriminability between severely injured and atelectatic lung areas after thoracic trauma can be substantially improved by virtual monoenergetic imaging from PCD-CT with superior contrast and visual discriminability at 40–50 keV.