Renal Stone Characterization using High Resolution Imaging Mode on a Photon Counting Detector CT System

A Prospective Study of the Diagnostic Performance of Photon-Counting CT Compared With MRI in the Characterization of Renal Masses

OBJECTIVES

The aim of this study was to assess the interreader reliability and per-RCC sensitivity of high-resolution photon-counting computed tomography (PCCT) in the detection and characterization of renal masses in comparison to MRI.

MATERIALS AND METHODS

This prospective study included 24 adult patients (mean age, 52 ± 14 years; 14 females) who underwent PCCT (using an investigational whole-body CT scanner) and abdominal MRI within a 3-month time interval and underwent surgical resection (partial or radical nephrectomy) with histopathology (n = 70 lesions). Of the 24 patients, 17 had a germline mutation and the remainder were sporadic cases. Two radiologists (R1 and R2) assessed the PCCT and corresponding MRI studies with a 3-week washout period between reviews. Readers recorded the number of lesions in each patient and graded each targeted lesion's characteristic features, dimensions, and location. Data were analyzed using a 2-sample t test, Fisher exact test, and weighted kappa.

RESULTS

In patients with von Hippel-Lindau mutation, R1 identified a similar number of lesions suspicious for neoplasm on both modalities (51 vs 50, P = 0.94), whereas R2 identified more suspicious lesions on PCCT scans as compared with MRI studies (80 vs 56, P = 0.12). R1 and R2 characterized more lesions as predominantly solid in MRIs (R1: 58/70 in MRI vs 52/70 in PCCT, P < 0.001; R2: 60/70 in MRI vs 55/70 in PCCT, P < 0.001). R1 and R2 performed similarly in detecting neoplastic lesions on PCCT and MRI studies (R1: 94% vs 90%, P = 0.5; R2: 73% vs 79%, P = 0.13).

CONCLUSIONS

The interreader reliability and per-RCC sensitivity of PCCT scans acquired on an investigational whole-body PCCT were comparable to MRI scans in detecting and characterizing renal masses.

CLINICAL RELEVANCE STATEMENT

PCCT scans have comparable performance to MRI studies while allowing for improved characterization of the internal composition of lesions due to material decomposition analysis. Future generations of this imaging modality may reveal additional advantages of PCCT over MRI.

Spectral Photon Counting CT: Imaging Algorithms and Performance Assessment

Photon counting x-ray detectors (PCDs) with spectral capabilities have the potential to revolutionize computed tomography (CT) for medical imaging. The ideal PCD provides accurate energy information for each incident x-ray, and at high spatial resolution. This information enables material-specific imaging, enhanced radiation dose efficiency, and improved spatial resolution in CT images. In practice, PCDs are affected by non-idealities, including limited energy resolution, pulse pileup, and cross talk due to charge sharing, K-fluorescence, and Compton scattering. In order to maximize their performance, PCDs must be carefully designed to reduce these effects and then later account for them during correction and post-acquisition steps. This review article examines algorithms for using PCDs in spectral CT applications, including how non-idealities impact image quality. Performance assessment metrics that account for spatial resolution and noise such as the detective quantum efficiency (DQE) can be used to compare different PCD designs, as well as compare PCDs with conventional energy integrating detectors (EIDs). These methods play an important role in enhancing spectral CT images and assessing the overall performance of PCDs.

Image quality assessment of a photon counting detector in x-ray projection imaging

The recent advancements in the photon counting detection have created a significant growing research interest in the x-ray imaging. It is essential to objectively understand the image quality parameters of a photon counting detector before developing imaging applications. In this work, we have assessed the imaging quality of a cadmium telluride (CdTe) based PCD in projection imaging mode. The detector is 70.4 mm × 6.6 mm dimensions. The detector has a pixel array of 64×4 with a pixel pitch of 1.1 mm×1.65 mm. With each pixel having 4 channels in its corresponding ASIC, this PCD can create three bin images from a single projection. With a microfocus x-ray source, the imaging quality in each bin image was measured in terms of the spatial resolution, noise, and contrast to noise ratio (CNR). We used 70 kV, 50μA, 10 s (0.5mAs) with 0.5mm thick aluminum (Al) filter for the acquisition of each image. The MTF curves indicated that the spatial resolution for the bin-1, bin-2, and bin-3 was almost identical. The NNPS curves indicated that the noise in bin 1 and bin 2 images was almost the same for all frequencies while bin 3 image had relatively less noise. The CNR analyses showed that the bin-1 image had the highest CNR. As the flux was increased from 0.5 to 1 mAs, the number of detected counts also increased that resulted in the CNR increase. Beyond this flux, the pulse pileup occurred due to which multiple counts were read as single that resulted in few detected counts and lower CNR. The knowledge of the spatial resolution, noise, and CNR in terms of energy binning allows the determination and optimization of imaging techniques necessary for various applications.