Esquivel Andrea, Potretzke Theodora, Ferrero Andrea, Inoue Akitoshi, Hoodeshenans Safa, Mileto Achille, Winfree Timothy, Yalon Mariana, Khandelwal Ashish, Rajendran Kishore, Thorne Jamison E, Lee Yong S, Potretzke Aaron, Leng Shuai, McCollough Cynthia H, Fletcher Joel G
Mayo Clinic, Rochester, MN, USA.
University of Washington, Seattle, WA, USA.
Abdom Radiol (NY). 2025 Jan 27. doi: 10.1007/s00261-024-04781-z.
To compare same-day photon-counting detector CT (PCD-CT) to conventional energy-integrating detector CT (EID-CT) for detection of small renal stones (≤ 3 mm).
Patients undergoing clinical dual-energy EID-CT for known or suspected stone disease underwent same-day research PCD-CT. Patients with greater than 10 stones and no visible stones under 3 mm were excluded. Three radiologists selected the optimal reconstruction configuration for each CT modality and created the reference standard for renal stone presence. Two other radiologists, blinded to imaging modality, independently reviewed anonymized images to detect renal stones, rating confidence in potential stones using a Likert scale (1 = Definitely present, 2 = Probably present, 3 = Questionably present, 4 = Not seen). Sensitivity and false positive detections for PCD and EID-CT were calculated.
Twenty-one patients underwent clinical EID-CT followed by same-day PCD-CT, with the reference standard identifying 121 renal stones (mean size 2.8 ± 2.6 mm). 0.4-mm PCD-CT images were more likely to display a stone as definitely present compared to 1- or 2-mm EID-CT images (p < 0.0001). Overall sensitivity for detection of all stones was greater at PCD-CT (0.75 vs. 0.55, p < 0.05). Pooled sensitivity of stones 3 mm was also significantly higher at PCD-CT (0.67 vs. 0.41, p < 0.05), with false positive detections differing between readers and modalities (PCD-CT vs. EID-CT: R1-7 v. 5; R2 - 7 v. 1).
Sensitivity for renal stones was significantly higher using high spatial resolution PCD-CT vs. EID-CT, especially for stones 3 mm or less in size, which may be important for at-risk patient populations. Prospective evaluation in larger patient populations that will benefit from detection of small stones is warranted.
比较当日光子计数探测器CT（PCD-CT）与传统能量积分探测器CT（EID-CT）检测小肾结石（≤3mm）的能力。
因已知或疑似结石病接受临床双能量EID-CT检查的患者，于当日接受研究性PCD-CT检查。排除结石数量超过10个以及未发现3mm以下可见结石的患者。三名放射科医生为每种CT模式选择最佳重建配置，并创建肾结石存在情况的参考标准。另外两名对成像模式不知情的放射科医生独立审查匿名图像以检测肾结石，使用李克特量表（1=肯定存在，2=可能存在，3=可疑存在，4=未发现）对潜在结石的可信度进行评级。计算PCD-CT和EID-CT的敏感性和假阳性检测率。
21例患者先接受临床EID-CT检查，随后当日接受PCD-CT检查，参考标准确定了121颗肾结石（平均大小2.8±2.6mm）。与1mm或2mm的EID-CT图像相比，0.4mm的PCD-CT图像更有可能明确显示结石存在（p<0.0001）。PCD-CT检测所有结石的总体敏感性更高（0.75对0.55，p<0.05）。PCD-CT对≤3mm结石的合并敏感性也显著更高（0.67对0.41，p<0.05），不同阅片者和模式之间的假阳性检测存在差异（PCD-CT对EID-CT：阅片者1-7对5；阅片者2-7对1）。
使用高空间分辨率的PCD-CT检测肾结石的敏感性显著高于EID-CT，尤其是对于大小≤3mm的结石，这对于高危患者群体可能很重要。有必要在更大的患者群体中进行前瞻性评估，这些患者将受益于小结石的检测。
