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Objectives <p>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.</p> Materials and methods <p>Comparing UHR-PCD-CTPA (<i>n</i> = 76 at image quality index (IQ) 50, <i>n</i> = 76 at IQ25) and dual-energy EID-CTPA (<i>n</i> = 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.</p> Results <p>Peripheral pulmonary artery visibility, overall image quality, and self-reported diagnostic confidence were higher in UHR-PCD-CTPA than in EID-CTPA (all <i>p</i> &lt; 0.01), with no relevant differences between IQ25 and IQ50 scans (all <i>p</i> &gt; 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 <i>p</i> &lt; 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 <i>p</i> &lt; 0.01).</p> Conclusion <p>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.</p> Key Points <p><Emphasis Type="BoldItalic">Question</Emphasis> <i>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.</i></p> <p><Emphasis Type="BoldItalic">Findings</Emphasis> <i>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.</i></p> <p><Emphasis Type="BoldItalic">Clinical relevance</Emphasis><i> 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.</i></p> Graphical Abstract <p></p>

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Increasing pulmonary artery visibility and diagnostic confidence with ultra-high resolution photon-counting detector CT pulmonary angiography

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月4日

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  • Pauline Pannenbecker,
  • Camilla Rüth,
  • Jan-Peter Grunz,
  • Alena Kollmann,
  • Philipp Gruschwitz,
  • Julius Frederik Heidenreich,
  • Andreas Steven Kunz,
  • Thorsten Alexander Bley,
  • Henner Huflage

摘要

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.

Graphical Abstract