Assessment of image quality in photon-counting detector computed tomography of the wrist - An ex vivo study

The aim of this study was to evaluate the effect of reconstruction parameters on image quality in wrist imaging using photon-counting detector CT (PCD-CT) and to compare the results with images from an energy-integrating detector CT (EID-CT).

Twelve cadaveric wrist specimens were examined using a prototype PCD-CT and a clinical EID-CT using similar radiation dose. Reconstruction parameters were matched between scanners. Also, sharper reconstruction kernels, a larger matrix size, and smaller slice thicknesses were evaluated for PCD-CT. Image noise, contrast-to-noise ratio (CNR) and image sharpness in trabecular structures were quantitatively measured. Image quality with respect to the visibility of cortical and trabecular bone structures was assessed by six radiologists using visual grading methods.

Images obtained with PCD-CT had lower noise (42.6 ± 3.9 HU vs 75.1 ± 6.3 HU), higher CNR (38.9 ± 4.5 vs 19.0 ± 2.4) and higher trabecular sharpness (63.5 ± 6.0 vs 53.7 ± 8.5) than those obtained with EID-CT using similar scan and reconstruction parameters (p < 0.001). The image sharpness in trabecular structures was further improved by using sharper kernels, despite higher noise levels. Radiologists had a strong preference for PCD-CT images both in terms of spatial resolution and suitability for bone imaging. Visual grading analysis showed an improved visibility of cortical bone, trabeculae and nutritive canals (p < 0.005).

PCD-CT offers improved image quality regarding bone structures in the wrist relative to EID-CT systems, particularly when sharper reconstruction kernels, smaller slice thickness and a larger image matrix size are used.