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Increasing pulmonary artery visibility and diagnostic confidence with ultra-high resolution photon-counting detector
Pauline Pannenbecker1,2, Camilla Rüth3, Jan-Peter Grunz3
1Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany. pannenbeck_p@ukw.de.
Objectives:
Photon-counting detector (PCD) CT allows for ultra-high-resolution (UHR) imaging of the pulmonary vasculature. The aim of this study was to assess the benefits of UHR-PCD-CT pulmonary angiography (CTPA) over dual-energy energy-integrating-detector (EID) CTPA.
Materials And Methods:
Comparing UHR-PCD-CTPA (n = 76 at image quality index (IQ) 50, n = 76 at IQ25) and dual-energy EID-CTPA (n = 75) acquired between April and October 2024, a total of 227 examinations were analyzed in this retrospective single-center study after excluding 56 ineligible studies. Hounsfield unit measurements and subjective image quality ratings of three radiologists (e.g., peripheral pulmonary artery visibility and diagnostic confidence) were investigated.
Results:
Peripheral pulmonary artery visibility, overall image quality, and self-reported diagnostic confidence were higher in UHR-PCD-CTPA than in EID-CTPA (all p < 0.01), with no relevant differences between IQ25 and IQ50 scans (all p > 0.05). Diagnostic confidence was stronger in UHR-PCD-CTPA vs. EID-CTPA (the two highest confidence scores reported by readers after viewing CTPAs and iodine-maps in 92.1-100% of IQ50, 94.6-100% of IQ25 and 66.6-73.3% of EID cases). Median attenuation in the pulmonary trunk was higher in UHR-PCD-CTPA (IQ25: 623.3 HU, IQ50: 567.8 HU) compared with EID-CTPA (397.2 HU, all p < 0.01). CT dose index was highest for IQ50 UHR-PCD-CTPA (6.7 ± 2.4 mGy), compared to EID-CTPA (4.7 ± 2.7 mGy) and IQ25 UHR-PCD-CTPA (3.0 ± 1.0 mGy; all p < 0.01).
Conclusion:
Image quality of CTPA benefits greatly from employing the UHR-mode in PCD-CT. Compared to EID-CTPA, even UHR-PCD-CTPA scans with a markedly lower radiation dose facilitate superior intraluminal attenuation, peripheral pulmonary artery visibility, and diagnostic confidence.
Key Points:
Question With the introduction of a UHR scan option for PCD-CT of the pulmonary vasculature, the question arises whether patients benefit from this recent technological advancement. Findings UHR-PCD-CTPA offers improved image quality, increased pulmonary artery visibility, and higher diagnostic confidence, even with significant dose reduction compared to conventional EID-CTPA. Clinical relevance The advantages in subjective and objective image quality described for UHR-PCD-CTPA suggest potential for superior diagnostic performance in the work-up of pulmonary embolism.
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