Arguello Fletes Gladys M, Zhou Wei, Malone LaDonna J, Fuentealba Cargill Andrea I, Weinman Jason P, Browne Lorna P
Department of Radiology, University of Colorado School of Medicine/Department of Pediatric Radiology, Children's Hospital Colorado, 13123 East 16th Avenue, Box 125, Aurora, 80045, Colorado, USA.
School of Medicine, University of Colorado, Aurora, USA.
Pediatr Radiol. 2025 Sep 5. doi: 10.1007/s00247-025-06336-w.
Previous studies have shown improved image quality in pediatric cardiac imaging using photon-counting detector CT (PCDCT). However, these studies did not evaluate image quality and radiation dose when utilizing the full spectral capabilities of PCDCT scanners. The full spectral capability of PCDCT scanners allows the generation of the entire array of mono-energetic reconstructions, virtual non-contrast (VNC) images, and iodine maps, which have potential advantages in evaluating complex congenital heart disease. For example, following complex congenital cardiac repairs, when distinguishing intraluminal or soft tissue calcifications from contrast, or when evaluating intrastent thrombus.
To compare image quality and radiation dose between high-pitch cardiac CT using full spectral PCDCT and dual-source energy-integrating detector CT (EIDCT).
This retrospective, IRB-approved study analyzed high-pitch cardiac CTs from January 2021 to October 2023 in pediatric patients (< 18 years). Patients were scanned using either PCDCT with full spectral technique ("QuantumPlus") or EIDCT. Radiation doses were measured by CT dose index (CTDI) and dose-length product (DLP). Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were also calculated, and image quality was assessed using a 5-point Likert scale. Statistical analysis included unpaired T-test, Shapiro-Wilk test, Mann-Whitney test, and kappa coefficients for interrater agreement.
Two hundred patients were evaluated, with 100 scanned on PCDCT and 100 on EIDCT. In the PCDCT scanner, 47/100 (47%) were male and 53/100 were female (53%) (P = 0.01). In the EIDCT scanner, 65/100 were male (65%) and 35/100 (35%) were female (P = 0.01). In the PCDCT scanner, 68/100 (68%) (P = 0.05) were ≤ 12 months, and 32/100 (32%) (P = 0.05) were > 12 months. In the EIDCT, 80/100 (80%) (P = 0.05) were ≤ 12 months, and 20/100 (20%) (P = 0.05) were > 12 months. In patients ≤ 12 months, the CNR were 31.61 in the PCDCT group and 32.14 in the EIDCT group (P = 0.39). For those > 12 months, CNR were 30.07 for PCDCT and 25.27 for EIDCT (P = 0.17). In patients ≤ 12 months, SNR was significantly lower (P < 0.0001) in PCDCT, compared to EIDCT for the teres minor muscles, while in patients > 12 months, SNR was not significantly lower (P = 0.89); SNR was similar between scanners. Radiation doses were significantly higher for PCDCT across both age groups (P < 0.0001).
High-pitch cardiac CT with PCDCT using spectral processing resulted in higher radiation doses and lower SNR in infants compared to EIDCT.
先前的研究表明，使用光子计数探测器CT（PCDCT）进行儿科心脏成像时图像质量有所提高。然而，这些研究在利用PCDCT扫描仪的全光谱功能时并未评估图像质量和辐射剂量。PCDCT扫描仪的全光谱功能允许生成一系列单能量重建图像、虚拟平扫（VNC）图像和碘图，这些在评估复杂先天性心脏病方面具有潜在优势。例如，在复杂先天性心脏修复术后，区分腔内或软组织钙化与造影剂时，或评估支架内血栓时。
比较使用全光谱PCDCT的高螺距心脏CT与双源能量积分探测器CT（EIDCT）之间的图像质量和辐射剂量。
这项经机构审查委员会批准的回顾性研究分析了2021年1月至2023年10月儿科患者（<18岁）的高螺距心脏CT。患者使用全光谱技术的PCDCT（“QuantumPlus”）或EIDCT进行扫描。通过CT剂量指数（CTDI）和剂量长度乘积（DLP）测量辐射剂量。还计算了信噪比（SNR）和对比噪声比（CNR），并使用5分李克特量表评估图像质量。统计分析包括非配对t检验、夏皮罗-威尔克检验、曼-惠特尼检验以及评估者间一致性的kappa系数。
共评估了200例患者，其中100例使用PCDCT扫描，100例使用EIDCT扫描。在PCDCT扫描仪组中，100例中有47例（47%）为男性，53例（53%）为女性（P = 0.01）。在EIDCT扫描仪组中，100例中有65例（65%）为男性，35例（35%）为女性（P = 0.01）。在PCDCT扫描仪组中，100例中有68例（68%）（P = 0.05）年龄≤12个月，32例（32%）（P = 0.05）年龄>12个月。在EIDCT组中，100例中有80例（80%）（P = 0.05）年龄≤12个月，20例（20%）（P = 0.05）年龄>12个月。在年龄≤12个月的患者中，PCDCT组CNR为31.61，EIDCT组为32.14（P = 0.39）。对于年龄>12个月的患者，PCDCT的CNR为30.07，EIDCT为25.27（P = 0.17）。在年龄≤12个月的患者中，PCDCT中小圆肌的SNR显著低于EIDCT（P < 0.0001），而在年龄>12个月的患者中，SNR没有显著降低（P = 0.89）；两台扫描仪之间的SNR相似。两个年龄组中PCDCT的辐射剂量均显著更高（P < 0.0001）。
与EIDCT相比，使用光谱处理的PCDCT进行高螺距心脏CT检查时，婴儿的辐射剂量更高，SNR更低。
