Rational and Objectives
To investigate the performance of a whole-body, photon-counting-detector (PCD) CT system in differentiating urinary stone composition.
Materials and Methods
Eighty-seven human urinary stones with pure mineral composition were placed in 4 anthropomorphic water phantoms (35 to 50 cm lateral dimension) and scanned on a PCD-CT system at 100, 120 and 140 kV. For each phantom size, tube current was selected to match CTDIvol to our clinical practice. Energy thresholds at [25, 65], [25, 70] and[25,75] keV for 100, 120 and 140 kV, respectively, were used to generate dual energy images. Each stone was automatically segmented using in-house software; CT number ratios were calculated and used to differentiate stone types in an ROC analysis. A comparison with second and third generation dual-source, dual-energy CT scanners with conventional energy integrating detectors (EID) was performed under matching conditions.
Results
For all investigated settings and smaller phantoms, perfect separation between uric acid (UA) and non-uric acid (NUA) stones was achieved (AUC = 1). For smaller phantoms, performance in differentiation of calcium oxalate (CaOx) and apatite (APA) stones was also similar between the 3 scanners: for the 35 cm phantom size, AUC values of 0.76, 0.79 and 0.80 were recorded for the second and third generation EID-CT and for the PCD-CT, respectively. For larger phantoms, PCD-CT and the third generation EID-CT outperformed the second generation EID-CT for both differentiation tasks: for a 50 cm phantom size and a UA/NUA differentiating task, AUC values of 0.63, 0.95 and 0.99 were recorded for the second and third generations EID-CT and for the PCD-CT, respectively.
Conclusion
PCD-CT provides comparable performance to state-of-the art EID-CT in differentiating urinary stone composition.