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Dedicated Photon-Counting CT for Detection and Classification of Microcalcifications: An Intraindividual Comparison
Luisa Charlotte Huck1, Maike Bode, Eloisa Zanderigo
1From the Department of Diagnostic and Interventional Radiology, University Hospital Aachen, Aachen, Germany (L.C.H., M.B., E.Z., C.W., V.R., E.D., C.K.K.); Department of Diagnostic and Interventional Radiology, University Hospital Freiburg, Freiburg, Germany (C.W.); Department of Radiology, University Hospital Erlangen, Erlangen, Germany (E.W.); and Department of Radiology, Radiology München, München, Germany (E.W.).
Photon-counting breast CT (PC-BCT) reliably detects most breast microcalcifications compared to digital breast tomosynthesis (DBT), but struggles with posterior lesions and individual morphology assessment. PC-BCT shows similar conspicuity and distribution analysis to DBT, with comparable radiation dose.
Area of Science:
- Radiology and Imaging
- Medical Physics
- Oncology
Background:
- Clinical experience with dedicated photon-counting breast CT (PC-BCT) for microcalcification diagnosis is limited.
- Digital breast tomosynthesis (DBT) is a standard screening tool, but PC-BCT offers potential for improved characterization.
- Accurate detection and classification of microcalcifications are crucial for early breast cancer diagnosis.
Purpose of the Study:
- To systematically compare the detection and classification capabilities of PC-BCT versus DBT for breast microcalcifications.
- To evaluate image quality, conspicuity, and morphologic assessment of microcalcifications between the two modalities.
- To determine the average glandular dose for PC-BCT and DBT.
Main Methods:
- Prospective intraindividual study involving women with suspicious microcalcifications (BI-RADS 4/5) detected on DBT.
- PC-BCT imaging with different reconstruction modes (RM-1, RM-2) and thin-slab MIP reconstructions.
- Independent radiologist assessment of microcalcification detection, distribution, morphology, and particle size; dose evaluation.
Main Results:
- Microcalcifications were detectable on PC-BCT in 20/22 participants; posterior lesions were missed.
- Conspicuity was similar between DBT and PC-BCT RM-1 MIPs (P=0.66), but significantly lower for other PC-BCT reconstructions.
- Excellent agreement for distribution (κ=0.91) but poor agreement for morphology (κ=0.44) between PC-BCT and DBT; smaller discernible particle size on PC-BCT due to blooming; comparable average glandular dose (PC-BCT: 7.04 mGy vs DBT: 6.88 mGy).
Conclusions:
- PC-BCT enables reliable detection of in-breast microcalcifications, excluding those in the posterior breast region.
- PC-BCT facilitates assessment of microcalcification distribution but is limited in evaluating individual morphology.
- Further optimization of PC-BCT reconstruction techniques is needed to improve microcalcification characterization.
