From the Department of Radiology, Mayo Clinic, Rochester, Minnesota.
AJNR Am J Neuroradiol. 2024 Oct 3;45(10):1441-1449. doi: 10.3174/ajnr.A8342.
BACKGROUND AND PURPOSE: Photon-counting detector CT (PCD-CT) is now clinically available and offers ultra-high-resolution (UHR) imaging. Our purpose was to prospectively evaluate the relative image quality and impact on diagnostic confidence of head CTA images acquired by using a PCD-CT compared with an energy-integrating detector CT (EID-CT). MATERIALS AND METHODS: Adult patients undergoing head CTA on EID-CT also underwent a PCD-CT research examination. For both CT examinations, images were reconstructed at 0.6 mm by using a matched standard resolution (SR) kernel. Additionally, PCD-CT images were reconstructed at the thinnest section thickness of 0.2 mm (UHR) with the sharpest kernel, and denoised with a deep convolutional neural network (CNN) algorithm (PCD-UHR-CNN). Two readers (R1, R2) independently evaluated image quality in randomized, blinded fashion in 2 sessions, PCD-SR versus EID-SR and PCD-UHR-CNN versus EID-SR. The readers rated overall image quality (1 [worst] to 5 [best]) and provided a Likert comparison score (-2 [significantly inferior] to 2 [significantly superior]) for the 2 series when compared side-by-side for several image quality features, including visualization of specific arterial segments. Diagnostic confidence (0-100) was rated for PCD versus EID for specific arterial findings, if present. RESULTS: Twenty-eight adult patients were enrolled. The volume CT dose index was similar (EID: 37.1 ± 4.7 mGy; PCD: 36.1 ± 4.0 mGy). Overall image quality for PCD-SR and PCD-UHR-CNN was higher than EID-SR (eg, PCD-UHR-CNN versus EID-SR: 4.0 ± 0.0 versus 3.0 ± 0.0 (R1), 4.9 ± 0.3 versus 3.0 ± 0.0 (R2); all values < .001). For depiction of arterial segments, PCD-SR was preferred over EID-SR (R1: 1.0-1.3; R2: 1.0-1.8), and PCD-UHR-CNN over EID-SR (R1: 0.9-1.4; R2: 1.9-2.0). Diagnostic confidence of arterial findings for PCD-SR and PCD-UHR-CNN was significantly higher than EID-SR: eg, PCD-UHR-CNN versus EID-SR: 93.0 ± 5.8 versus 78.2 ± 9.3 (R1), 88.6 ± 5.9 versus 70.4 ± 5.0 (R2); all values < .001. CONCLUSIONS: PCD-CT provides improved image quality for head CTA images compared with EID-CT, both when PCD and EID reconstructions are matched, and to an even greater extent when PCD-UHR reconstruction is combined with a CNN denoising algorithm.
背景与目的：光子计数探测器 CT（PCD-CT）现已在临床上投入使用，可提供超高分辨率（UHR）成像。本研究旨在前瞻性评估与能量积分探测器 CT（EID-CT）相比，头部 CTA 图像采用 PCD-CT 采集的相对图像质量和对诊断信心的影响。 材料与方法：在 EID-CT 上接受头部 CTA 检查的成年患者也接受了 PCD-CT 研究检查。对于这两种 CT 检查，均采用匹配的标准分辨率（SR）内核在 0.6mm 层厚重建图像。此外，PCD-CT 图像在最薄的 0.2mm 层厚（UHR）采用最锐利的内核重建，并使用深度卷积神经网络（CNN）算法（PCD-UHR-CNN）进行降噪。两名读者（R1、R2）在 2 个会话中以随机、盲法的方式独立评估图像质量，PCD-SR 与 EID-SR 以及 PCD-UHR-CNN 与 EID-SR 进行比较。当以并排方式比较时，读者会对特定动脉段的可视化等多种图像质量特征进行总体图像质量（1[最差]至 5[最佳]）评分，并提供-2[明显差]至 2[明显优]的李克特比较评分。如果存在特定的动脉发现，则对 PCD 与 EID 进行诊断信心（0-100）评分。 结果：共纳入 28 名成年患者。容积 CT 剂量指数相似（EID：37.1±4.7mGy；PCD：36.1±4.0mGy）。与 EID-SR 相比，PCD-SR 和 PCD-UHR-CNN 的总体图像质量更高（例如，PCD-UHR-CNN 与 EID-SR：4.0±0.0 与 3.0±0.0（R1），4.9±0.3 与 3.0±0.0（R2）；所有 值<0.001）。对于动脉段的显示，PCD-SR 优于 EID-SR（R1：1.0-1.3；R2：1.0-1.8），PCD-UHR-CNN 优于 EID-SR（R1：0.9-1.4；R2：1.9-2.0）。PCD-SR 和 PCD-UHR-CNN 的动脉发现诊断信心明显高于 EID-SR：例如，PCD-UHR-CNN 与 EID-SR：93.0±5.8 与 78.2±9.3（R1），88.6±5.9 与 70.4±5.0（R2）；所有 值<0.001。 结论：与 EID-CT 相比，PCD-CT 可为头部 CTA 图像提供更高的图像质量，无论是 PCD 和 EID 重建匹配时，还是当 PCD-UHR 重建与 CNN 降噪算法结合使用时，图像质量的改善更为显著。
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