Photon Counting Research Articles

Editorial Comment: A Spectrum of Opportunities—Photon-Counting Detector CT and Osteoporosis

Editorial Comment: A Spectrum of Opportunities—Photon-Counting Detector CT and Osteoporosis

Combined influence of quantum iterative reconstruction level and kernel sharpness on image quality in photon counting CT angiography of the upper leg

AbstractAim was to evaluate the influence of different quantum iterative reconstruction (QIR) levels on the image quality of femoral photon-counting CT angiographies (PCD-CTA).Ultra-high resolution PCD-CTA were obtained from both extremities of five extracorporeally-perfused cadavers using constant tube voltage and maximum radiation dose (71.2 ± 11.0 mGy). Images were reconstructed with three kernels (Bv48, Bv60, Bv76) and the four available levels of QIR. Signal attenuation in the arterial lumen, muscle, and fat were measured. Contrast-to-noise ratios (CNR) and blurring scores were calculated for objective assessment. Six radiologists evaluated the subjective image quality using a pairwise comparison tool.Higher QIR level resulted in a decisive image noise reduction, especially with sharper convolution kernels (Bv60: Q1 11.5 ± 6.3 HU vs. Q4 8.4 ± 2.6 HU; p < 0.001). Largest improvement of CNR was recorded with ultra-sharp reconstructions (Bv76: Q1 20.2 ± 4.4 vs. Q4 28.0 ± 3.5; p < 0.001). Blurring decreased with higher QIR levels for soft Bv48, remained constant for medium Bv60, and increased for sharp Bv76 reconstructions. Subjective QIR level preference varied kernel depending, preferred combinations were: Bv48/Q4, Bv60/Q2, Bv76/Q3. Interrater agreement was excellent.Sharp kernels benefited most from noise reduction of higher QIR levels in lower extremity PCD-CTA. In sum, QIR level 3 provided the best objective and subjective image quality results.

Room temperature single-photon terahertz detection with thermal Rydberg atoms

Single-photon terahertz (THz) detection is one of the most demanding technologies for a variety of fields and could lead to many breakthroughs. Although significant progress has been made in the past two decades, operating it at room temperature still remains a great challenge. Here, we demonstrate, for the first time, a room temperature THz detector at single-photon levels based on nonlinear wave mixing in thermal Rydberg atomic vapor. The low-energy THz photons are coherently upconverted to high-energy optical photons via a nondegenerate Rydberg state involved in a six-wave mixing process, and therefore, single-photon THz detection is achieved by a conventional optical single-photon counting module. The noise equivalent power of such a detector reaches 9.5 × 10−19 W/Hz1/2, which is more than four orders of magnitude lower than the state-of-the-art room temperature THz detectors. The optimum quantum efficiency of the whole-wave mixing process is about 4.3%, with 40.6 dB dynamic range, and the maximum conversion bandwidth is 172 MHz, which is all-optically controllable. The developed fast and continuous-wave single-photon THz detector at room temperature operation has a great potential for portability and chip-scale integration, and could be revolutionary for a wide range of applications in remote sensing, wireless communication, biomedical diagnostics, and quantum optics.

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

Modeling the effect of superconductor properties on sensitivity and responsivity of superconducting nanowire single photon detector

Superconducting nanowire single photon detector (SNSPD) is a leading candidate for applications requiring the fundamental limit of light detection at high detection rates. While SNSPD technology employing nanowires from conventional low temperature superconducting detectors is mature with several commercial solutions, other material options with higher transition temperature approaching liquid nitrogen with faster signal responses are actively being explored. In this context, we develop a comprehensive model that predicts the final potential response from an SNSPD incorporating several physical and material aspects. A phase diagram of photon detection is developed that describes the latching phases and the photon sensitivity as a function of biasing current and temperature for both low temperature and high temperature superconductors. On the one hand, while low temperature superconductors are observed to be more sensitive than high temperature superconductors (HTSs) under any given biasing condition, a biasing window for a single photon detection with HTS nanowires is identified. On the other hand, HTS nanowires demonstrate three orders of magnitude faster response times than the low temperature superconductor nanowire at the same biasing condition, making it uniquely suited for several practical applications.

Kinetic inductance current sensor for visible to near-infrared wavelength transition-edge sensor readout

Single-photon detectors based on the superconducting transition-edge sensor are used in a number of visible to near-infrared applications, particularly for photon-number-resolving measurements in quantum information science. To be practical for large-scale spectroscopic imaging or photonic quantum computing applications, the size of visible to near-infrared transition-edge sensor arrays and their associated readouts must be increased from a few pixels to many thousands. In this manuscript, we introduce the kinetic inductance current sensor, a scalable readout technology that exploits the nonlinear kinetic inductance in a superconducting resonator to make sensitive current measurements. Kinetic inductance current sensors can replace superconducting quantum interference devices for many applications because of their ability to measure fast, high slew-rate signals, their compatibility with standard microwave frequency-division multiplexing techniques, and their relatively simple fabrication. Here, we demonstrate the readout of a visible to near-infrared transition-edge sensor using a kinetic inductance current sensor with 3.7 MHz of bandwidth. We measure a readout noise of 1.4pA/Hz\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$1.4\\,{{{\\rm{pA}}}}/\\sqrt{{{{\\rm{Hz}}}}}$$\\end{document}, considerably below the detector noise at frequencies of interest, and an energy resolution of (0.137 ± 0.001) eV at 0.8 eV, comparable to resolutions observed with non-multiplexed superconducting quantum interference device readouts.

Frequency-locked Si3N4 microring for Doppler frequency shift detection

In this paper, we propose to use a homemade all-fiber Si3N4 microring as the frequency discriminator for Doppler frequency shift detection. The full width at half maximum of the microring is 361.83 MHz, which covers the dynamic range of ± 70 m/s for wind measurement applications. By introducing a time-division multiplexing method, we have achieved the frequency locking of the microring to the central frequency of the laser source, which effectively stabilizes the measurement accuracy against perturbations such as temperature fluctuations. By alternatively upshifting and downshifting the pulses, a dual-frequency lasing scheme has been designed to realize the double-edge technique for frequency shift detection. A commercial single-photon detector with 25% quantum efficiency and approximately 1300 Hz dark count rate is used to detect the backscattered signals, which circumvents the need for bulky and expensive superconducting single-photon detectors. The proposed system is validated through an outdoor wind speed detection experiment using a reference anemometer. The experiment results demonstrate the feasibility of using microring as the frequency discriminator and that the precise frequency locking control is able to improve the measurement accuracy to the state-of-the-art level under the influence of perturbations, which highlights the potential for highly integrated direct detection Doppler wind lidar design.

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.

Cost-effectiveness of ultrahigh-resolution photon-counting detector coronary CT angiography for the evaluation of stable chest pain

BackgroundThe increased specificity of ultrahigh-resolution (UHR) photon-counting detector (PCD)-CT over energy-integrating detector (EID)-CT for coronary CT angiography (CCTA) could defer unwarranted downstream tests. The objective of the study was to simulate the cost-effectiveness of UHR CCTA in stable chest pain patients with coronary calcifications. MethodsA decision and simulation model was developed using Monte Carlo simulations with 1000 bootstrap resamples to estimate the costs associated with PCD-CT in lieu of EID-CT for CCTA and the referral for subsequent testing. The model was constructed using the diagnostic accuracy metrics of 55 coronary lesions in patients who underwent CCTA on both CT systems and subsequent invasive coronary angiography (ICA). Sensitivity and specificity were defined for each Coronary Artery Disease Reporting and Data System category. The aggregate healthcare expenditures were derived from the hospital billing system. ResultsAssuming a projected cohort of 15,000 patients over the lifetime of the PCD-CT, its implementation resulted in a 18.9 ​% reduction in the number of functional follow-up tests (6330.3 ​± ​59.5 vs. 5135.7 ​± ​60.6, p ​< ​0.001), a 6.0 ​% reduction in performed ICAs (1447.7 ​± ​36.2 vs. 1360.2 ​± ​34.7, p ​< ​0.001), and a 9.4 ​% decrease in major procedure-related complications. Over a 10-year expected life expectancy, PCD-CT led to an average cost saving of $794.50 ​± ​18.50 per patient and an overall cost difference of $11,917,500 ​± ​4,350,169. ConclusionsPCD-CT has the potential to reduce the financial burden on healthcare systems and procedure-related complications for stable chest pain patients with coronary calcification when compared to EID-CT.

Diagnostic performance of high and ultra-high-resolution photon counting CT for detection of coronary artery disease in patients evaluated for transcatheter aortic valve implantation.

We assessed the diagnostic performance of both ultra-high-resolution (UHR) and high-resolution (HR) modes of photon-counting detector (PCD)-CT within the confines of standard pre-TAVI CT scans, as well as the performance of UHR mode adjusted specifically for coronary imaging, using quantitative coronary angiography (QCA) as the reference. We included 60 patients undergoing pre-TAVI planning CT scans. Patients were divided into 3 groups: 20 scanned in HR mode, 20 in UHR mode, and 20 in adjusted UHR mode, on a dual-source PCD-CT. The adjusted UHR mode employed a lower tube voltage (90kV vs. 120kV) and a higher image quality level (65 vs. 34) to enhance coronary artery visualization. Patients underwent invasive coronary angiography as part of clinical routine. CCTA and QCA were reviewed to assess CAD presence defined as stenosis ≥ 50% in proximal and middle coronary segments. We included 60 patients (mean age 79 ± 7 years; 39(65%) men). Mean heart rate during scanning was 72 ± 13bpm. Median coronary calcium score was 973[379-2007]. QCA identified significant CAD in 24 patients (40%): 9 patients scanned with HR mode, 10 patients with the UHR mode, and 5 patients with the UHR adjusted mode. Per-patient area under the curves were 0.57 for HR, 0.80 for UHR, and 0.80 for adjusted UHR, with no significant differences between the scan modes, and per-vessel the area under the curves were 0.73 for HR, 0.69 for UHR, and 0.87 for adjusted UHR, with significant differences between UHR and adjusted UHR (p = 0.04). UHR and adjusted UHR modes of dual source PCD-CT show potential for improved sensitivity and negative predictive value for detecting CAD in patients undergoing pre-TAVI scans, however, no statistically significant difference from HR mode was observed.

Superconducting nanowire single-photon detector enhanced near-infrared II portable confocal microscopy for tissue imaging with indocyanine green

In this Letter a novel, to our knowledge, approach for near-infrared (NIR) fluorescence portable confocal microscopy is introduced, aiming to enhance fluorescence imaging of biological samples in the NIR-II window. By integrating a superconducting nanowire single-photon detector (SNSPD) into a confocal microscopy, we have significantly leveraged the detection efficiency of the NIR-II fluorescence signal from indocyanine green (ICG), an FDA-approved dye known for its NIR-II fluorescence capabilities. The SNSPD, characterized by its extremely low dark count rate and optimized NIR system detection efficiency, enables the excitation of ICG with 1 mW and the capture of low-light fluorescence signals from deep regions (up to 512 µm). Consequently, our technique was able to produce high-resolution images of bio samples with a superior signal-to-noise ratio, making a substantial advancement in the field of fluorescence microscopy and offering a promising opportunity for future clinical study.

Ge-on-Si single-photon avalanche diode using a double mesa structure

We present experimental results of Ge-on-Si single-photon avalanche diodes based on a novel, to our knowledge, double mesa structure. Using this structure, the electric field at the mesa edges is suppressed compared to a traditional single mesa, leading to significant performance improvements. The dark current in linear mode shows a smaller increase for larger reverse voltages, resulting in a reduction by more than 260 times at low temperatures. Operated in the Geiger-mode at 110 K, the dark count rate in the double mesa is 100 times smaller. The devices achieve a dark count rate of 953 kHz, a single-photon detection efficiency of 7.3%, and a record-low jitter of 81 ps at an excess bias of 17.6% and a temperature of 110 K.

High-sensitivity and spatial resolution benchtop cone beam XFCT imaging system with pixelated photon counting detectors using enhanced multipixel events correction method

Objective.High atomic number element nanoparticles have shown potential in tumor diagnosis and therapy. X-ray fluorescence computed tomography (XFCT) technology enables quantitative imaging of high atomic number elements by specifically detecting characteristic x-ray signals. The potential for further biomedical applications of XFCT depends on balancing sensitivity, spatial resolution, and imaging speed in existing XFCT imaging systems.Approach.In this study, we utilized a high-energy resolution pixelated photon-counting detector for XFCT imaging. We tackled degradation caused by multi-pixel events in the photon-counting detector through energy and interaction position corrections. Sensitivity and spatial resolution imaging experiments were conducted using PMMA phantoms to validate the effectiveness of the multi-pixel events correction algorithm.Main results.After correction, the system's sensitivity and spatial resolution have both improved. Furthermore, XFCT/CBCT dual-modality imaging of gadolinium nanoparticles within mice subcutaneous tumor was successfully achieved.Significance.These results demonstrate the preclinical research application potential of the XFCT/CBCT dual-modality imaging system in high atomic number nanoparticle-based tumor diagnosis and therapy.

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

Objective&#xD;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.&#xD;Approach&#xD;A European Spine Phantom (ESP) with hydroxyapatite (HA 0.5, 1.0 and 1.5 g/cm2) 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 phantom anteroposterior thicknesses (18, 26, 34, and 40 cm) were simulated 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), and 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 software, and aBMD was calculated after background correction. In vivo performance of PCD-based aBMD was illustrated using a patient scan acquired at 140 kV and 40 mA, and lumbar aBMD were compared with the DXA.&#xD;Main results&#xD;The ESP aBMD values from PCD-localizers demonstrated excellent day-to-day stability with a coefficient-of-variation ranging from 0.42-0.53%, with Mean Absolute Percentage Errors (MAPE) of less than 5% for all three vertebral bodies. The coefficient-of-variation for weekly scans ranged from 0.17-0.60%, again with MAPE below 5% for all three vertebral bodies. Across phantom sizes and tube currents, the MAPE values varied ranging from 1.84 - 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 0.07-9.82% for different lumbar vertebra.&#xD;Significance&#xD;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.

Two-Way Single-Photon Laser Time Transfer for High-Speed Moving Platforms

The two-way laser time transfer technology, based on single-photon detection, is among the techniques requiring the least weight and power consumption for ultra-long-distance clock synchronization. It holds promise as the most viable technology for high-accuracy inter-satellite clock synchronization, particularly for small satellites that are highly sensitive to weight and power consumption. In this study, we analyze laser time transfer in fast-moving platforms and find that not only does the relative motion speed between platforms significantly impact the clock offset measurement, but also the components of each platform’s relative motion velocity are critical. We introduce a lightweight scenario for laser time transfer, capable of achieving high-precision and high-accuracy interstellar clock offset measurements within a 5000 km range using high repetition rate microchip lasers and single-pixel single-photon detectors. With a speed accuracy of ±0.06 m/s, the precision of clock offset measurement surpasses 3 ps at full width at half maximum (FWHM), making it suitable for high-speed and high-precision clock synchronization between near-Earth satellites.

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.

Assessing myocardial tissue in the acute setting with Photon-Counting CT (PCCT) in comparison with Cardiac Magnetic Resonance (CMR)

Abstract Background Cardiac magnetic resonance (CMR) characterization of myocardial tissue is routinely used in clinical practice. Compared to traditional CT, Photon counting CT (PCCT) uses photon-counting detectors offering higher spatial resolution, elimination of electronic noise and improved contrast-to-noise ratio. A comparison between CMR and PCCT for myocardial characterizazion in an urgent setting, however, has not yet been explored. Purpose The aim of this study was to compare the ability to characterize myocardial tissue between PCCT and CMR in patients presenting with acute chest pain in the emergency department (ED). Methods This single-center prospective study enrolled all consecutive patients presenting to the ED of our hospital from November 2023 to January 2024 with chest pain, ECG alterations and troponin rise consistent with myocardial injury. Patients needing urgent coronary angiography according to guidelines were excluded. PCCT was performed urgently for triple rule-out, but also for tissue characterization through post-iodine-contrast administration images. Within 24 hours, all patients underwent a CMR protocol including T2-weighted and late gadolinium enhancement (LGE) images for tissue characterization. Results Six male patients with a mean age of 20 ± 10 years were enrolled. All clinical, PCCT, and CMR parameters are presented in Table 1. All patients presented with diffuse ST-segment elevation and exhibited T2-weighted images (for edema detection) and LGE distribution (subepicardial and intramyocardial) consistent with acute myocarditis. Mean radiation exposure for PCCT was 0.8±0.1 mSv. A strong linear correlation emerged between PCCT-derived delayed enhancement (DE) volume and CMR-derived late gadolinium enhancement (LGE) volume (r = 0.970; p value 0.001) (Table 1). Similar results were achieved when comparing the number of DE and LGE myocardial segments (r = 0.871; p value 0.026). Significant correlations also emerged between DE, LGE, and high-sensitive troponin (hsTN) at presentation (respectively: PCCT-DE vs hsTN r = 0.951, p value 0.004; CMR-LGE vs hsTN r = 0.918, p value 0.010). CMR showed a much higher signal-to-noise ratio (SNR) for the delayed enhanced myocardium and contrast-to-noise (CNR) ratio between the delayed enhanced and normal myocardium with respect to PCCT in post-contrast images (respectively 7.4 ± 3.9 vs 27.2 ± 17.7, p value 0.024 and 5.5 ± 3.7 vs 38.8 ± 30.2, p value 0.023). In T2-weighted images both SNR for the hyperintense myocardium (30.3 [20.4-122.4]) and CNR between the hyperintense and normal myocardium (26.7 [13.3-60.2]) resulted to be higher compared to PCCT (p value 0.027 and 0.045, respectively) (Table 1). Conclusions PCCT appears to be reliable when compared to CMR for detecting myocardial edema through the acquisition of post-contrast images in the acute setting with an acceptable CNR.