Intra-individual comparison of image quality of the coronary arteries between photon-counting detector and energy-integrating detector CT systems

• Published in: European journal of radiology Vol. 166; p. 111008
• Main Authors: Pinos, Daniel, Griffith, Joseph, Emrich, Tilman, Schoepf, U. Joseph, O'Doherty, Jim, Zsarnoczay, Emese, Fink, Nicola, Vecsey-Nagy, Milan, Suranyi, Pal, Tesche, Christian, Aquino, Gilberto J., Varga-Szemes, Akos, Brandt, Verena
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.09.2023
• Subjects: Computed tomography; Coronary arteries; CT angiography; Image quality; Photon-counting CT; Virtual monoenergetic imaging; EID; CTDIvol; T3D; Virtual monoenergetic imaging; CNR; CAD; Photon-counting CT; ATVS; Image quality; PCD; SD; CCTA; VMI; Computed tomography; CT angiography; QIR; Coronary arteries; ADMIRE; BMI
• ISSN: 0720-048X; 1872-7727; 1872-7727
• DOI: 10.1016/j.ejrad.2023.111008

•Intraindividual comparison of photon-counting and energy-integrating systems for CCTA.•Virtual monoenergetic images were generated for photon-counting detector CT (PCD-CT)•PCD-CT improves objective and subjective image quality across many keV levels.•Incrementally greater impact was found for patients with obesity. To intra-individually compare the objective and subjective image quality of coronary computed tomography angiography (CCTA) between photon-counting detector CT (PCD-CT) and energy-integrating detector CT (EID-CT). Consecutive patients undergoing clinically indicated CCTA on an EID-CT system were prospectively enrolled for a research CCTA performed on a PCD-CT system within 30 days. Polychromatic images were reconstructed for both EID- and PCD-CT, while virtual monoenergetic images (VMI) were generated at 40, 45, 50, 55, 60 and 70 keV for PCD-CT. Two blinded readers calculated contrast-to-noise ratio (CNR) for each major coronary artery and rated image noise, vessel attenuation, vessel sharpness, and overall quality on a 1–5 Likert scale. Patients were then stratified by body mass index (BMI) [high (>30 kg/m2) vs low (<30 kg/m2)] for subgroup analysis. A total of 20 patients (67.5 ± 9.0 years, 75% male) were included in the study. Compared with EID-CT, coronary artery CNR values from PCD-CT monoenergetic and polychromatic reconstructions were all significantly higher than CNR values from EID-CT, with incrementally greater differences in obese subjects (all p < 0.008). Subjective image noise and sharpness were also significantly higher for all VMI reconstructions compared to EID-CT (all p < 0.008). All subjective scores were significantly higher for 55, 60, and 70 keV PCD-CT than EID-CT values (all p < 0.05). The improved objective and subjective image quality of PCD-CT compared to EID-CT may provide better visualization of the coronary arteries for a wide array of patients, especially those with a high BMI.