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Photon-Counting Computed Tomography (PC-CT) of the spine: impact on diagnostic confidence and radiation dose

OBJECTIVES: Computed tomography (CT) is employed to evaluate surgical outcome after spinal interventions. Here, we investigate the potential of multispectral photon-counting computed tomography (PC-CT) on image quality, diagnostic confidence, and radiation dose compared to an energy-integrating CT (...

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Autores principales: Rau, Alexander, Straehle, Jakob, Stein, Thomas, Diallo, Thierno, Rau, Stephan, Faby, Sebastian, Nikolaou, Konstantin, Schoenberg, Stefan O., Overhoff, Daniel, Beck, Jürgen, Urbach, Horst, Klingler, Jan-Helge, Bamberg, Fabian, Weiss, Jakob
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10326119/
https://www.ncbi.nlm.nih.gov/pubmed/36890304
http://dx.doi.org/10.1007/s00330-023-09511-5
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author Rau, Alexander
Straehle, Jakob
Stein, Thomas
Diallo, Thierno
Rau, Stephan
Faby, Sebastian
Nikolaou, Konstantin
Schoenberg, Stefan O.
Overhoff, Daniel
Beck, Jürgen
Urbach, Horst
Klingler, Jan-Helge
Bamberg, Fabian
Weiss, Jakob
author_facet Rau, Alexander
Straehle, Jakob
Stein, Thomas
Diallo, Thierno
Rau, Stephan
Faby, Sebastian
Nikolaou, Konstantin
Schoenberg, Stefan O.
Overhoff, Daniel
Beck, Jürgen
Urbach, Horst
Klingler, Jan-Helge
Bamberg, Fabian
Weiss, Jakob
author_sort Rau, Alexander
collection PubMed
description OBJECTIVES: Computed tomography (CT) is employed to evaluate surgical outcome after spinal interventions. Here, we investigate the potential of multispectral photon-counting computed tomography (PC-CT) on image quality, diagnostic confidence, and radiation dose compared to an energy-integrating CT (EID-CT). METHODS: In this prospective study, 32 patients underwent PC-CT of the spine. Data was reconstructed in two ways: (1) standard bone kernel with 65-keV (PC-CT(std)) and (2) 130-keV monoenergetic images (PC-CT(130 keV)). Prior EID-CT was available for 17 patients; for the remaining 15, an age–, sex–, and body mass index–matched EID-CT cohort was identified. Image quality (5-point Likert scales on overall, sharpness, artifacts, noise, diagnostic confidence) of PC-CT(std) and EID-CT was assessed by four radiologists independently. If metallic implants were present (n = 10), PC-CT(std) and PC-CT(130 keV) images were again assessed by 5-point Likert scales by the same radiologists. Hounsfield units (HU) were measured within metallic artifact and compared between PC-CT(std) and PC-CT(130 keV). Finally, the radiation dose (CTDI(vol)) was evaluated. RESULTS: Sharpness was rated significantly higher (p = 0.009) and noise significantly lower (p < 0.001) in PC-CTstd vs. EID-CT. In the subset of patients with metallic implants, reading scores for PC-CT(130 keV) revealed superior ratings vs. PC-CT(std) for image quality, artifacts, noise, and diagnostic confidence (all p < 0.001) accompanied by a significant increase of HU values within the artifact (p < 0.001). Radiation dose was significantly lower for PC-CT vs. EID-CT (mean CTDI(vol): 8.83 vs. 15.7 mGy; p < 0.001). CONCLUSIONS: PC-CT of the spine with high-kiloelectronvolt reconstructions provides sharper images, higher diagnostic confidence, and lower radiation dose in patients with metallic implants. KEY POINTS: • Compared to energy-integrating CT, photon-counting CT of the spine had significantly higher sharpness and lower image noise while radiation dose was reduced by 45%. • In patients with metallic implants, virtual monochromatic photon-counting images at 130 keV were superior to standard reconstruction at 65 keV in terms of image quality, artifacts, noise, and diagnostic confidence.
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spelling pubmed-103261192023-07-08 Photon-Counting Computed Tomography (PC-CT) of the spine: impact on diagnostic confidence and radiation dose Rau, Alexander Straehle, Jakob Stein, Thomas Diallo, Thierno Rau, Stephan Faby, Sebastian Nikolaou, Konstantin Schoenberg, Stefan O. Overhoff, Daniel Beck, Jürgen Urbach, Horst Klingler, Jan-Helge Bamberg, Fabian Weiss, Jakob Eur Radiol Musculoskeletal OBJECTIVES: Computed tomography (CT) is employed to evaluate surgical outcome after spinal interventions. Here, we investigate the potential of multispectral photon-counting computed tomography (PC-CT) on image quality, diagnostic confidence, and radiation dose compared to an energy-integrating CT (EID-CT). METHODS: In this prospective study, 32 patients underwent PC-CT of the spine. Data was reconstructed in two ways: (1) standard bone kernel with 65-keV (PC-CT(std)) and (2) 130-keV monoenergetic images (PC-CT(130 keV)). Prior EID-CT was available for 17 patients; for the remaining 15, an age–, sex–, and body mass index–matched EID-CT cohort was identified. Image quality (5-point Likert scales on overall, sharpness, artifacts, noise, diagnostic confidence) of PC-CT(std) and EID-CT was assessed by four radiologists independently. If metallic implants were present (n = 10), PC-CT(std) and PC-CT(130 keV) images were again assessed by 5-point Likert scales by the same radiologists. Hounsfield units (HU) were measured within metallic artifact and compared between PC-CT(std) and PC-CT(130 keV). Finally, the radiation dose (CTDI(vol)) was evaluated. RESULTS: Sharpness was rated significantly higher (p = 0.009) and noise significantly lower (p < 0.001) in PC-CTstd vs. EID-CT. In the subset of patients with metallic implants, reading scores for PC-CT(130 keV) revealed superior ratings vs. PC-CT(std) for image quality, artifacts, noise, and diagnostic confidence (all p < 0.001) accompanied by a significant increase of HU values within the artifact (p < 0.001). Radiation dose was significantly lower for PC-CT vs. EID-CT (mean CTDI(vol): 8.83 vs. 15.7 mGy; p < 0.001). CONCLUSIONS: PC-CT of the spine with high-kiloelectronvolt reconstructions provides sharper images, higher diagnostic confidence, and lower radiation dose in patients with metallic implants. KEY POINTS: • Compared to energy-integrating CT, photon-counting CT of the spine had significantly higher sharpness and lower image noise while radiation dose was reduced by 45%. • In patients with metallic implants, virtual monochromatic photon-counting images at 130 keV were superior to standard reconstruction at 65 keV in terms of image quality, artifacts, noise, and diagnostic confidence. Springer Berlin Heidelberg 2023-03-09 2023 /pmc/articles/PMC10326119/ /pubmed/36890304 http://dx.doi.org/10.1007/s00330-023-09511-5 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Musculoskeletal
Rau, Alexander
Straehle, Jakob
Stein, Thomas
Diallo, Thierno
Rau, Stephan
Faby, Sebastian
Nikolaou, Konstantin
Schoenberg, Stefan O.
Overhoff, Daniel
Beck, Jürgen
Urbach, Horst
Klingler, Jan-Helge
Bamberg, Fabian
Weiss, Jakob
Photon-Counting Computed Tomography (PC-CT) of the spine: impact on diagnostic confidence and radiation dose
title Photon-Counting Computed Tomography (PC-CT) of the spine: impact on diagnostic confidence and radiation dose
title_full Photon-Counting Computed Tomography (PC-CT) of the spine: impact on diagnostic confidence and radiation dose
title_fullStr Photon-Counting Computed Tomography (PC-CT) of the spine: impact on diagnostic confidence and radiation dose
title_full_unstemmed Photon-Counting Computed Tomography (PC-CT) of the spine: impact on diagnostic confidence and radiation dose
title_short Photon-Counting Computed Tomography (PC-CT) of the spine: impact on diagnostic confidence and radiation dose
title_sort photon-counting computed tomography (pc-ct) of the spine: impact on diagnostic confidence and radiation dose
topic Musculoskeletal
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10326119/
https://www.ncbi.nlm.nih.gov/pubmed/36890304
http://dx.doi.org/10.1007/s00330-023-09511-5
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