Photon Counting CT Angiography of the Head and Neck: Image Quality Assessment of Polyenergetic and Virtual Monoenergetic Reconstructions

Michael, Arwed Elias; Boriesosdick, Jan; Schoenbeck, Denise; Lopez-Schmidt, Ingo; Kroeger, Jan Robert; Moenninghoff, Christoph; Horstmeier, Sebastian; Pennig, Lenhard; Borggrefe, Jan

doi:10.3390/diagnostics12061306

Cited by 11 publications

(9 citation statements)

References 37 publications

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“…Even for CTA imaging with standard iodine agents, PCD scanners appear advantageous: similar to the contrast load reduction facilitated by monoenergetic reconstructions in dual-energy EID-CT, 34 the use of PCD-CT enables a substantially lower iodine dosage in vascular scans of the head and neck. 25 Despite the improved image quality of PCD-CTA examinations, their influence on the diagnostic accuracy of radiologists with regard to vascular pathologies such as stenoses remains to be investigated in future research. In this context, the option of ultra-highresolution examinations with spectral image information and no dose penalty should also be evaluated.…”

Section: Discussionmentioning

confidence: 99%

“…The intrinsic spectral capabilities and higher luminal attenuation of PCD-CT would potentially allow for a broader use of this application in the future (see Supplemental Figure S3, http://links.lww.com/RLI/A812). Even for CTA imaging with standard iodine agents, PCD scanners appear advantageous: similar to the contrast load reduction facilitated by monoenergetic reconstructions in dual-energy EID-CT, 34 the use of PCD-CT enables a substantially lower iodine dosage in vascular scans of the head and neck 25 …”

Section: Discussionmentioning

confidence: 99%

“…The registration of each single x-ray photon as an electrical current further allows to set a threshold to exclude the low-energetic electronic noise from the count rate. 15,16 Although previous publications confirm the positive effect of PCD-CT in cardiac examinations, [17][18][19] abdominal vessels, [20][21][22][23] or assessment of the head and neck, [24][25][26] the potential in CTA of the lower extremity is currently underinvestigated. 27 To fill this significant research gap, a continuous extracorporeal perfusion model based on cadaveric specimens was designed to allow for intraindividual comparisons between CTA examinations performed with different dose levels and scanners.…”

mentioning

confidence: 99%

“…The registration of each single x-ray photon as an electrical current further allows to set a threshold to exclude the low-energetic electronic noise from the count rate 15,16 . Although previous publications confirm the positive effect of PCD-CT in cardiac examinations, 17–19 abdominal vessels, 20–23 or assessment of the head and neck, 24–26 the potential in CTA of the lower extremity is currently underinvestigated 27 …”

mentioning

confidence: 99%

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Photon-Counting Versus Energy-Integrating Detector CT Angiography of the Lower Extremity in a Human Cadaveric Model With Continuous Extracorporeal Perfusion

et al. 2023

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Objectives Detailed visualization of the arterial runoff is mandatory for the assessment of peripheral arterial occlusive disease. This study aims to compare the performance of a first-generation photon-counting detector computed tomography (PCD-CT) to a third-generation energy-integrating detector CT (EID-CT). Materials and Methods Computed tomography angiographies of 8 upper leg arterial runoffs were performed on human cadaveric models with continuous extracorporeal perfusion. For both PCD-CT and EID-CT, radiation dose-equivalent 120 kVp acquisition protocols (low-/medium-/high-dose: CTDIVol = 3/5/10 mGy) were used. All scans were performed with standard collimation (PCD-CT: 144 × 0.4 mm; EID-CT: 96 × 0.6 mm), a pitch factor of 0.4, and a gantry rotation time of 1.0 second. Reformatting of data included the use of comparable vascular kernels (Bv 48/49), a slice thickness and increment of 1.0 mm, and a field of view of 150 × 150 mm. Eight radiologists evaluated image quality independently using a browser-based pairwise forced-choice comparison setup. Kendall concordance coefficient (W) was calculated to estimate interrater agreement. Signal-to-noise ratio and contrast-to-noise ratio (CNR) were compared based on 1-way analyses of variance and linear regression analysis. Results Low-dose PCD-CT achieved superior signal-to-noise ratio/CNR values compared with high-dose EID-CT (P < 0.001). Linear regression analysis suggested that an EID-CT scan with a CTDIVol of at least 15.5 mGy was required to match the CNR value of low-dose PCD-CT. Intraluminal contrast attenuation was higher in PCD-CT than EID-CT, irrespective of dose level (415.0 ± 31.9 HU vs 329.2 ± 29.4 HU; P < 0.001). Subjective image quality of low-dose PCD-CT was considered superior to high-dose EID-CT (P < 0.001). Interrater agreement was high (W = 0.989). Conclusions Using cadaveric models with continuous extracorporeal perfusion allows for intraindividual image quality comparisons between PCD-CT and EID-CT on variable dose levels. With superior luminal contrast attenuation and denoising in angiographies of the peripheral arterial runoff, PCD-CT displayed potential for radiation saving of up to 83% compared with EID-CT.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Photon-Counting Versus Energy-Integrating Detector CT Angiography of the Lower Extremity in a Human Cadaveric Model With Continuous Extracorporeal Perfusion

et al. 2023

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“…42,55 Regarding head and neck imaging, PCD-CTA has been shown to provide excellent image quality in clinical routine by using polyenergetic or monoenergetic reconstructions of the extracranial and intracranial arteries. 56 However, a well-known obstacle deteriorating image quality in angiographies, in addition to beam-hardening, is blooming artifacts that impede visualization of the vessel lumen next to arteriosclerotic calcified plaques or implanted stents or coils. A potential solution to these issues may be offered by exploiting the inherent spectral data of PCD-CT to reconstruct VMIs and material concentration maps.…”

Section: Vascular Imaging Of the Head And Neckmentioning

confidence: 99%

Advanced Neuroimaging With Photon-Counting Detector CT

Abel¹,

Schubert²,

Winklhofer³

2023

Invest Radiol

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Photon-counting detector computed tomography (PCD-CT) is an emerging technology and promises the next step in CT evolution. Photon-counting detectors count the number of individual incoming photons and assess the energy level of each of them. These mechanisms differ substantially from conventional energy-integrating detectors. The new technique has several advantages, including lower radiation exposure, higher spatial resolution, reconstruction of images with less beam-hardening artifacts, and advanced opportunities for spectral imaging. Research PCD-CT systems have already demonstrated promising results, and recently, the first whole-body full field-of-view PCD-CT scanners became clinically available. Based on published studies of preclinical systems and the first experience with clinically approved scanners, the performance can be translated to valuable neuroimaging applications, including brain imaging, intracranial and extracranial CT angiographies, or head and neck imaging with detailed assessment of the temporal bone. In this review, we will provide an overview of the current status in neuroimaging with upcoming and potential clinical applications.

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Nonenhanced Photon Counting CT of the Head

Michael,

Schoenbeck,

Woeltjen

et al. 2023

Clin Neuroradiol

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Purpose Nonenhanced computed tomography (CT) of the head is among the most commonly performed CT examinations. The spectral information acquired by photon counting CT (PCCT) allows generation of virtual monoenergetic images (VMI). At the same time, image noise can be reduced using quantum iterative reconstruction (QIR). In this study, the image quality of VMI was evaluated depending on the keV level and the QIR level. Furthermore, the influence of the cranial calvaria was investigated to determine the optimal reconstruction for clinical application. Methods A total of 51 PCCT (NAEOTOM Alpha, Siemens Healthineers, Erlangen, Germany) of the head were retrospectively analyzed. In a quantitative analysis, gray and white matter ROIs were evaluated in different brain areas at all available keV levels and QIR levels with respect to signal, noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR). The distance to the cranial calvaria of the ROIs was included in the analysis. This was followed by a qualitative reading by five radiologists including experienced neuroradiologists. Results In most ROIs, signal and noise varied significantly between keV levels (p < 0.0001). The CNR had a focal maximum at 66 keV and an absolute maximum at higher keV, slightly differently located depending on ROI and QIR level. With increasing QIR level, a significant reduction in noise was achieved (p < 0.0001) except just beneath the cranial calvaria. The cranial calvaria had a strong effect on the signal (p < 0.0001) but not on gray and white matter noise. In the qualitative reading, the 60 keV VMI was rated best. Conclusion In nonenhanced PCCT of the head the selected keV level of the VMI and the QIR level have a crucial influence on image quality in VMI. The 60 keV and 66 keV VMI with high QIR level provided optimal subjective and objective image quality for clinical use. The cranial calvaria has a significant influence on the visualization of the adjacent brain matter; currently, this substantially limits the use of low keV VMIs (< 60 keV).

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Photon Counting CT Angiography of the Head and Neck: Image Quality Assessment of Polyenergetic and Virtual Monoenergetic Reconstructions

Cited by 11 publications

References 37 publications

Photon-Counting Versus Energy-Integrating Detector CT Angiography of the Lower Extremity in a Human Cadaveric Model With Continuous Extracorporeal Perfusion

Photon-Counting Versus Energy-Integrating Detector CT Angiography of the Lower Extremity in a Human Cadaveric Model With Continuous Extracorporeal Perfusion

Advanced Neuroimaging With Photon-Counting Detector CT

Nonenhanced Photon Counting CT of the Head

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