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Purpose <p>This study investigated whether contrast enhanced whole-body photon-counting detector (PCD)-CT performed for staging in the prone position can provide breast lesion conspicuity comparable to dynamic contrast-enhanced T1-weighted imaging (DCE-T1WI).</p> Methods <p>This single-center, retrospective diagnostic feasibility study included 22 women with surgically confirmed primary breast cancer who underwent preoperative prone PCD-CT and DCE-MRI. Then, 40- and 70-keV virtual monoenergetic image (VMI) from a single arterial-phase PCD-CT acquisition were reconstructed. Three readers independently evaluated 40- and 70-keV VMI and DCE-T1WI. The primary endpoint was lesion conspicuity. The secondary endpoints included, size error, detection rate, background parenchymal enhancement (BPE), subjective noise, and reading time.</p> Results <p>Lesion conspicuity was highest on 40-keV VMI, which outperformed 70-keV VMI and DCE-T1WI. Absolute size error was numerically larger for 40-keV VMI than for DCE-T1WI, but this difference was not statistically significant. Directional error indicated that 40-keV VMI significantly underestimated lesion size relative to DCE-T1WI. Detection rates showed an overall difference among modalities, but pairwise differences were not statistically significant. Further, 40-keV VMI had a higher BPE and a greater perceived noise than 70-keV VMI, and it required a longer reading time than DCE-T1WI. The radiation dose did not differ between VMI energy levels as both were reconstructed from the same acquisition.</p> Conclusion <p>Arterial-phase 40-keV VMIs from prone PCD-CT demonstrated the highest lesion conspicuity and showed better detection capability than 70-keV VMI. In addition, their performance was comparable to or superior to DCE-T1WI. This finding was achieved despite trade-offs in increased noise, BPE and size underestimation. Thus, 40-keV VMI may serve as a useful complementary modality for local breast assessment and may be considered a potential alternative for lesion localization when MRI is not feasible, despite potential underestimation of lesion extent.</p>

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Lesion conspicuity assessment of prone 40-keV virtual monoenergetic imaging in arterial-phase photon-counting CT for breast cancer: a retrospective comparison with DCE-MRI

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月31日

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  • Yusuke Kawasaki,
  • Maika Nakajima,
  • Kota Yokoyama,
  • Emi Yamaga,
  • Makoto Kato,
  • Leona Katsuta,
  • Ken Yamagiwa,
  • Hiroto Hada,
  • Takumi Hiraishi,
  • Hirofumi Yamada,
  • Junichi Tsuchiya,
  • Susumu Kirimura,
  • Iichiroh Onishi,
  • Tomoyuki Aruga,
  • Ukihide Tateishi

摘要

Purpose

This study investigated whether contrast enhanced whole-body photon-counting detector (PCD)-CT performed for staging in the prone position can provide breast lesion conspicuity comparable to dynamic contrast-enhanced T1-weighted imaging (DCE-T1WI).

Methods

This single-center, retrospective diagnostic feasibility study included 22 women with surgically confirmed primary breast cancer who underwent preoperative prone PCD-CT and DCE-MRI. Then, 40- and 70-keV virtual monoenergetic image (VMI) from a single arterial-phase PCD-CT acquisition were reconstructed. Three readers independently evaluated 40- and 70-keV VMI and DCE-T1WI. The primary endpoint was lesion conspicuity. The secondary endpoints included, size error, detection rate, background parenchymal enhancement (BPE), subjective noise, and reading time.

Results

Lesion conspicuity was highest on 40-keV VMI, which outperformed 70-keV VMI and DCE-T1WI. Absolute size error was numerically larger for 40-keV VMI than for DCE-T1WI, but this difference was not statistically significant. Directional error indicated that 40-keV VMI significantly underestimated lesion size relative to DCE-T1WI. Detection rates showed an overall difference among modalities, but pairwise differences were not statistically significant. Further, 40-keV VMI had a higher BPE and a greater perceived noise than 70-keV VMI, and it required a longer reading time than DCE-T1WI. The radiation dose did not differ between VMI energy levels as both were reconstructed from the same acquisition.

Conclusion

Arterial-phase 40-keV VMIs from prone PCD-CT demonstrated the highest lesion conspicuity and showed better detection capability than 70-keV VMI. In addition, their performance was comparable to or superior to DCE-T1WI. This finding was achieved despite trade-offs in increased noise, BPE and size underestimation. Thus, 40-keV VMI may serve as a useful complementary modality for local breast assessment and may be considered a potential alternative for lesion localization when MRI is not feasible, despite potential underestimation of lesion extent.