Performance of Spectral Photon-Counting Coronary CT Angiography and Comparison with Energy-Integrating-Detector CT: Objective Assessment with Model Observer

Aims: To evaluate spectral photon-counting CT’s (SPCCT) objective image quality characteristics in vitro, compared with standard-of-care energy-integrating-detector (EID) CT. Methods: We scanned a thorax phantom with a coronary artery module at 10 mGy on a prototype SPCCT and a clinical dual-layer EID-CT under various conditions of simulated patient size (small, medium, and large). We used filtered back-projection with a soft-tissue kernel. We assessed noise and contrast-dependent spatial resolution with noise power spectra (NPS) and target transfer functions (TTF), respectively. Detectability indices (d’) of simulated non-calcified and lipid-rich atherosclerotic plaques were computed using the non-pre-whitening with eye filter model observer. Results: SPCCT provided lower noise magnitude (9–38% lower NPS amplitude) and higher noise frequency peaks (sharper noise texture). Furthermore, SPCCT provided consistently higher spatial resolution (30–33% better TTF(10)). In the detectability analysis, SPCCT outperformed EID-CT in all investigated conditions, providing superior d’. SPCCT reached almost perfect detectability (AUC ≈ 95%) for simulated 0.5-mm-thick non-calcified plaques (for large-sized patients), whereas EID-CT had lower d’ (AUC ≈ 75%). For lipid-rich atherosclerotic plaques, SPCCT achieved 85% AUC vs. 77.5% with EID-CT. Conclusions: SPCCT outperformed EID-CT in detecting simulated coronary atherosclerosis and might enhance diagnostic accuracy by providing lower noise magnitude, markedly improved spatial resolution, and superior lipid core detectability.